Healthcare Provider Details

I. General information

NPI: 1326298480
Provider Name (Legal Business Name): LIDA ROSANNE BLUE LPC, CAADC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 N STATE ST
CARO MI
48723-1584
US

IV. Provider business mailing address

2200 S FENNER RD
CARO MI
48723-9671
US

V. Phone/Fax

Practice location:
  • Phone: 989-673-5700
  • Fax:
Mailing address:
  • Phone: 989-673-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501003428
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401226276
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-05424
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6401226276
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401226276
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401226276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: