| Blue Lotus Healing Center, Llc | |
|
8838 Us Highway 70 W Suite 200c Clayton NC 27520-4822 | |
| (919) 946-8644 | |
| (919) 550-2913 |
| Full Name | Blue Lotus Healing Center, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 8838 Us Highway 70 W, Clayton, North Carolina |
| Authorized Official Name and Position | Nivien Ibrahim (OWNER) |
| Authorized Official Contact | 9199468644 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Lotus Healing Center, Llc Po Box 1831 Clayton NC 27528-1831 Ph: (919) 946-8644 | Blue Lotus Healing Center, Llc 8838 Us Highway 70 W Suite 200c Clayton NC 27520-4822 Ph: (919) 946-8644 |
| NPI Number | 1922206416 |
|---|---|
| Provider Enumeration Date | 07/05/2007 |
| Last Update Date | 04/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922206416 | NPI | - | NPPES |
| 1415Y | Other | NC | BCBS |
| 6106317 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C004122 (North Carolina) | Primary |
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