Provider Demographics
NPI:1477693208
Name:BLUE RIDGE COMMUNITY & COUNSELING
Entity Type:Organization
Organization Name:BLUE RIDGE COMMUNITY & COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:OCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS RN NCC LPC ALPS
Authorized Official - Phone:304-263-0345
Mailing Address - Street 1:PO BOX 1282
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402
Mailing Address - Country:US
Mailing Address - Phone:304-263-0345
Mailing Address - Fax:304-263-0367
Practice Address - Street 1:213 WEST JOHN STREET
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-263-0345
Practice Address - Fax:304-263-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV919101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV919OtherWV BOARD OF EXAMINERS