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General NPI Number Information
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NPI Number | 1750523387
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE COUNSELING, LLC
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 76 SANDCASTLE COURT
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City | DAWSONVILLE
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State | GA
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Zip | 30534-7075
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Country | US
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Telephone | 706-974-3899
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Fax | 866-242-0878
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Provider Business Mailing Address
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Address Line | PO BOX 2017
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City | DAWSONVILLE
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State | GA
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Zip | 30534-0036
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Country | US
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Telephone | 706-974-3899
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. JOSEPH MITCHELL STAPP
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Credential | MA, LPC, NCC
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Telephone | 706-974-3899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC004711
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License Number State | GA
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