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: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SANDUSKY LN
RALEIGH NC
27614-7513
US

IV. Provider business mailing address

1400 SANDUSKY LN
RALEIGH NC
27614-7513
US

V. Phone/Fax

Practice location:
  • Phone: 919-438-3576
  • Fax:
Mailing address:
  • Phone: 919-438-3576
  • Fax:

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: