| Organization Name: | BLUERIDGE COUNSELING SERVICES |
| NPI Number: | 1053448878 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEITH E FENDER (PRESIDENT) |
| Mailing Address: | 519 2nd St Radford |
| State: | VA US |
| Postal Code: | 241411403 |
| Phone Number: | 5406399040 |
| Fax Number: | 5406399040 |
| NPI Enumeration Date: | 02/28/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 0904004405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |