Healthcare Provider Details

I. General information

NPI: 1073400560
Provider Name (Legal Business Name): BLUE RIDGE EXPRESSIVE ARTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 NEW MARKET BLVD
BOONE NC
28607-3765
US

IV. Provider business mailing address

299 TAMBRAS WAY
VILAS NC
28692-6011
US

V. Phone/Fax

Practice location:
  • Phone: 828-767-9942
  • Fax:
Mailing address:
  • Phone: 828-773-1365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. TYLER A DEAL
Title or Position: OWNER/PROVIDER
Credential: LCMHC
Phone: 828-773-1365