Provider Demographics
NPI:1093509382
Name:BLUE, KALI M (EDS, LPCA, NCC)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:M
Last Name:BLUE
Suffix:
Gender:
Credentials:EDS, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 OLD AIRPORT RD APT 825
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-0923
Mailing Address - Country:US
Mailing Address - Phone:803-417-4404
Mailing Address - Fax:
Practice Address - Street 1:405 PETTIGRU ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3114
Practice Address - Country:US
Practice Address - Phone:864-271-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health