Healthcare Provider Details

I. General information

NPI: 1144952441
Provider Name (Legal Business Name): LAUREN HAILEY BLAIR LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 LYCKAN PKWY STE 1001
DURHAM NC
27707-2565
US

IV. Provider business mailing address

3622 LYCKAN PKWY STE 1001
DURHAM NC
27707-2565
US

V. Phone/Fax

Practice location:
  • Phone: 919-602-6766
  • Fax: 919-402-1755
Mailing address:
  • Phone: 919-602-6766
  • Fax: 919-402-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17619
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: