Healthcare Provider Details

I. General information

NPI: 1578701389
Provider Name (Legal Business Name): FELIPE KHRISTOPHER BLUE LCAS-P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MAIN ST STE 316
DURHAM NC
27701-3228
US

IV. Provider business mailing address

201 W MAIN ST STE 316
DURHAM NC
27701-3228
US

V. Phone/Fax

Practice location:
  • Phone: 919-729-6300
  • Fax:
Mailing address:
  • Phone: 919-679-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number845
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2579
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number19243
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number11265
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: