Healthcare Provider Details

I. General information

NPI: 1841941671
Provider Name (Legal Business Name): BLUE RIDGE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E LOUTHER ST STE 204
CARLISLE PA
17013-2646
US

IV. Provider business mailing address

401 E LOUTHER ST STE 204
CARLISLE PA
17013-2646
US

V. Phone/Fax

Practice location:
  • Phone: 717-918-9961
  • Fax: 717-918-9961
Mailing address:
  • Phone: 717-918-9961
  • Fax: 717-918-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: EMILY FENNER
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 717-918-9961