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General NPI Number Information
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NPI Number | 1770034902
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Entity Type | Organization
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Legal Business Name | BLACKSBURG BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 2001 S MAIN ST SUITE 108
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City | BLACKSBURG
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State | VA
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Zip | 24060-6678
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Country | US
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Telephone | 540-443-8949
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Fax | 540-739-2111
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Provider Business Mailing Address
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Address Line | 2001 S MAIN ST SUITE 108
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City | BLACKSBURG
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State | VA
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Zip | 24060-6678
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Country | US
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Telephone | 540-443-8949
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Fax | 540-739-2111
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | ADRIENNE JILL MEANS-CHRISTENSEN
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Credential | PH.D.
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Telephone | 540-443-8949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810004182
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License Number State | VA
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