Healthcare Provider Details

I. General information

NPI: 1528986023
Provider Name (Legal Business Name): BALANCED PATH THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S MAIN ST STE 105
BLACKSBURG VA
24060-6667
US

IV. Provider business mailing address

506 FOREST HILL DR
BLACKSBURG VA
24060-5908
US

V. Phone/Fax

Practice location:
  • Phone: 540-200-8625
  • Fax:
Mailing address:
  • Phone: 540-420-5226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PETER GOLLADAY
Title or Position: MANAGING MEMBER
Credential: LCSW
Phone: 540-200-8625