Basic Information
| Provider Information | |||||||||
| NPI: | 1265096507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLUE | ||||||||
| FirstName: | AALLIYAH | ||||||||
| MiddleName: | NATALIA LANAE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2235 POYDRAS ST UNIT B | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701197576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045247205 | ||||||||
| FaxNumber: | 5045814702 | ||||||||
| Practice Location | |||||||||
| Address1: | 2235 POYDRAS ST UNIT B | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701197576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045247205 | ||||||||
| FaxNumber: | 5045814702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2019 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YA0400X | LA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.