Provider Demographics
NPI:1770034902
Name:BLACKSBURG BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:BLACKSBURG BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:MEANS-CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:540-443-8949
Mailing Address - Street 1:2001 S MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6678
Mailing Address - Country:US
Mailing Address - Phone:540-443-8949
Mailing Address - Fax:540-739-2111
Practice Address - Street 1:2001 S MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6678
Practice Address - Country:US
Practice Address - Phone:540-443-8949
Practice Address - Fax:540-739-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004182103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty