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General NPI Number Information
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NPI Number | 1063285484
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE BEHAVIORAL HEALTH ASSOCIATES
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 37775 HUGHESVILLE RD
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City | PURCELLVILLE
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State | VA
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Zip | 20132-4131
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Country | US
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Telephone | 617-257-3139
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Fax |
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Provider Business Mailing Address
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Address Line | 37775 HUGHESVILLE RD
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City | PURCELLVILLE
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State | VA
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Zip | 20132-4131
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Country | US
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Telephone | 617-257-3139
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KATHLEEN YOUNGMAN
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Credential | PMHNP-BC, FNP-C,APRN
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Telephone | 617-257-3139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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