Healthcare Provider Details

I. General information

NPI: 1851162010
Provider Name (Legal Business Name): BLUE RIDGE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 E MARKET ST # V79
LEESBURG VA
20176-3255
US

IV. Provider business mailing address

1198 HAWLING PL SW
LEESBURG VA
20175-5084
US

V. Phone/Fax

Practice location:
  • Phone: 571-569-0560
  • Fax:
Mailing address:
  • Phone: 571-334-9759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE BIXBY HUGHES
Title or Position: OWNER
Credential: NP
Phone: 571-334-9759