Healthcare Provider Details

I. General information

NPI: 1619021888
Provider Name (Legal Business Name): BLUERIDGE PSYCH ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 MEDICAL RIDGE ROAD CLINTON
CLINTON SC
29325
US

IV. Provider business mailing address

PO BOX 645
CAMPOBELLO SC
29322-0645
US

V. Phone/Fax

Practice location:
  • Phone: 864-415-2981
  • Fax: 864-895-2996
Mailing address:
  • Phone: 864-415-2981
  • Fax: 864-895-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number133
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1215
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1440
License Number StateGA

VIII. Authorized Official

Name: DR. RON O THOMPSON
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 864-415-2981