Provider Demographics
NPI:1427888494
Name:BLUE, CHERESE SMITH (LCMHCA)
Entity type:Individual
Prefix:
First Name:CHERESE
Middle Name:SMITH
Last Name:BLUE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:CHERESE
Other - Middle Name:SMITH
Other - Last Name:BLUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHCA
Mailing Address - Street 1:2200 SILAS CREEK PKWY STE 8A
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5000
Mailing Address - Country:US
Mailing Address - Phone:336-464-7445
Mailing Address - Fax:
Practice Address - Street 1:2200 SILAS CREEK PKWY STE 8A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5000
Practice Address - Country:US
Practice Address - Phone:336-464-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health