| Organization Name: | BLUE RIDGE COUNSELING |
| NPI Number: | 1104239474 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUZANNE KELLY (PARTNER) |
| Mailing Address: | 110 W Elm St Yadkinville |
| State: | NC US |
| Postal Code: | 270558203 |
| Phone Number: | 3366773991 |
| Fax Number: | 3366771359 |
| NPI Enumeration Date: | 06/04/2014 |
| NPI Last Update Date: | 06/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1223 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |