Organization
BLUE LOTUS HEALING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIVIEN IBRAHIM LCSW (OWNER)
(919) 946-8644
Entity
Organization
Contact information
Practice address
8838 US HIGHWAY 70 W, SUITE 200C, CLAYTON, NC 27520-4822
(919) 946-8644
(919) 550-2913
Mailing address
PO BOX 1831, CLAYTON, NC 27528-1831
(919) 946-8644
(919) 363-9971
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C004122
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1415Y
BCBS
NC
05
—
6106317
—
NC
Enumeration date
07/05/2007
Last updated
04/02/2015
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