Individual
CIJI LATRICE BLUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSWA
Contact information
Practice address
6319 RAEFORD RD APT 71, FAYETTEVILLE, NC 28304-2838
(919) 760-3026
Mailing address
PO BOX 26269, FAYETTEVILLE, NC 28314-5021
(919) 760-3026
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C009062
NC
Other
Enumeration date
09/18/2012
Last updated
10/02/2014
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