Healthcare Provider Details

I. General information

NPI: 1518369727
Provider Name (Legal Business Name): NIADRA BLOUNT PRATT MS, LCAS, CCS, LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIADRA CHANTE BLOUNT LCASA

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 NC HWY 33 WEST
CHOCOWINITY NC
27817
US

IV. Provider business mailing address

PO BOX 644
CHOCOWINITY NC
27817-0644
US

V. Phone/Fax

Practice location:
  • Phone: 252-256-7219
  • Fax: 252-364-3414
Mailing address:
  • Phone: 252-256-7219
  • Fax: 252-364-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCASA20451
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA15315
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: