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General NPI Number Information
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NPI Number | 1619732450
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Entity Type | Organization
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Legal Business Name | BLUE ROSE CONSULTING GROUP, INC
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Dates
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Enumeration Date | 02/20/2024
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 880 HARRISON ST SE STE 162
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City | LEESBURG
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State | VA
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Zip | 20175-4530
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Country | US
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Telephone | 202-774-2059
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Fax |
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Provider Business Mailing Address
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Address Line | 880 HARRISON ST SE STE 162
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City | LEESBURG
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State | VA
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Zip | 20175-4530
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Country | US
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Telephone | 202-774-2059
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | DR. WILLARD H MEEKS
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Credential | PSY.D.
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Telephone | 202-774-2059
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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