Provider Demographics
NPI:1851421184
Name:BLUE RIDGE FIRST STEP
Entity Type:Organization
Organization Name:BLUE RIDGE FIRST STEP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PHOEBE
Authorized Official - Middle Name:V
Authorized Official - Last Name:FLIAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:434-295-0334
Mailing Address - Street 1:198 SPOTNAP RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8614
Mailing Address - Country:US
Mailing Address - Phone:434-295-0334
Mailing Address - Fax:434-295-0450
Practice Address - Street 1:198 SPOTNAP RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8614
Practice Address - Country:US
Practice Address - Phone:434-295-0334
Practice Address - Fax:434-295-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06261Medicare ID - Type Unspecified