Healthcare Provider Details

I. General information

NPI: 1154936698
Provider Name (Legal Business Name): BLUE DOOR COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 HWY 70 EAST SUITE 130
GARNER NC
27529
US

IV. Provider business mailing address

223 US 70 HWY E STE 130
GARNER NC
27529-4062
US

V. Phone/Fax

Practice location:
  • Phone: 919-892-3677
  • Fax:
Mailing address:
  • Phone: 919-228-9097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JENNIFER CANDON
Title or Position: OWNER/COUNSELOR
Credential: LCMHC
Phone: 919-228-9097