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General NPI Number Information
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NPI Number | 1073400560
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE EXPRESSIVE ARTS, INC.
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 379 NEW MARKET BLVD
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City | BOONE
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State | NC
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Zip | 28607-3765
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Country | US
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Telephone | 828-767-9942
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Fax |
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Provider Business Mailing Address
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Address Line | 299 TAMBRAS WAY
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City | VILAS
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State | NC
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Zip | 28692-6011
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Country | US
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Telephone | 828-773-1365
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. TYLER A DEAL
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Credential | LCMHC
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Telephone | 828-773-1365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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