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General NPI Number Information
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NPI Number | 1518788686
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 3740 BREVARD RD #216
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City | HORSE SHOE
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State | NC
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Zip | 28742-1137
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Country | US
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Telephone | 336-515-1193
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Fax |
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Provider Business Mailing Address
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Address Line | 3740 BREVARD RD #216
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City | HORSE SHOE
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State | NC
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Zip | 28742-1137
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Country | US
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Telephone | 336-515-1193
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Fax |
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Authorized Official
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Title or Position | CLINICAL OUTREACH MANAGER, CO-OWNER
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Name | DR. CECILIA P FAUST
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Credential | MD
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Telephone | 336-515-1193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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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 | 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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