Provider Demographics
NPI:1619732450
Name:BLUE ROSE CONSULTING GROUP, INC
Entity Type:Organization
Organization Name:BLUE ROSE CONSULTING GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:202-774-2059
Mailing Address - Street 1:880 HARRISON ST SE STE 162
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4530
Mailing Address - Country:US
Mailing Address - Phone:202-774-2059
Mailing Address - Fax:
Practice Address - Street 1:880 HARRISON ST SE STE 162
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4530
Practice Address - Country:US
Practice Address - Phone:202-774-2059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty