Provider Demographics
NPI:1851482434
Name:BLUE RIDGE PSYCHOLOGICAL SERVICES, P.A.
Entity Type:Organization
Organization Name:BLUE RIDGE PSYCHOLOGICAL SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-782-4980
Mailing Address - Street 1:3726 CAMLEY AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4320
Mailing Address - Country:US
Mailing Address - Phone:919-782-4980
Mailing Address - Fax:919-781-7277
Practice Address - Street 1:3726 CAMLEY AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4320
Practice Address - Country:US
Practice Address - Phone:919-782-4980
Practice Address - Fax:919-781-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty