Provider Demographics
NPI:1760704852
Name:BLUE RIDGE ALTERNATIVES, LLC
Entity Type:Organization
Organization Name:BLUE RIDGE ALTERNATIVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:HENSLEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:276-228-8300
Mailing Address - Street 1:385 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2621
Mailing Address - Country:US
Mailing Address - Phone:276-228-8300
Mailing Address - Fax:
Practice Address - Street 1:695 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2034
Practice Address - Country:US
Practice Address - Phone:276-228-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040050701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7471563OtherAETNA
VA102148OtherANTHEM