Provider Demographics
NPI:1851156533
Name:BLUE RIDGE BEHAVIORAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:BLUE RIDGE BEHAVIORAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:YBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, QASP-S
Authorized Official - Phone:830-556-2604
Mailing Address - Street 1:440 MONTICELLO AVE STE 1802 PMB 491643
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510
Mailing Address - Country:US
Mailing Address - Phone:830-556-2604
Mailing Address - Fax:210-547-7984
Practice Address - Street 1:440 MONTICELLO AVE STE 1802 PMB 491643
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510
Practice Address - Country:US
Practice Address - Phone:830-556-2604
Practice Address - Fax:210-547-7984
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
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty