Provider Demographics
NPI:1053448878
Name:BLUERIDGE COUNSELING SERVICES
Entity Type:Organization
Organization Name:BLUERIDGE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:FENDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-639-9040
Mailing Address - Street 1:519 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1403
Mailing Address - Country:US
Mailing Address - Phone:540-639-9040
Mailing Address - Fax:540-639-9040
Practice Address - Street 1:519 2ND ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1403
Practice Address - Country:US
Practice Address - Phone:540-639-9040
Practice Address - Fax:540-639-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040044051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty