Provider Demographics
NPI:1265096507
Name:BLUE, AALLIYAH NATALIA LANAE
Entity type:Individual
Prefix:
First Name:AALLIYAH
Middle Name:NATALIA LANAE
Last Name:BLUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 POYDRAS ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7576
Mailing Address - Country:US
Mailing Address - Phone:504-524-7205
Mailing Address - Fax:504-581-4702
Practice Address - Street 1:2235 POYDRAS ST UNIT B
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7576
Practice Address - Country:US
Practice Address - Phone:504-524-7205
Practice Address - Fax:504-581-4702
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator