Provider Demographics
NPI:1124656798
Name:PINE RIDGE THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:PINE RIDGE THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MOYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:304-777-9384
Mailing Address - Street 1:2285 ROSE HILL CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-7588
Mailing Address - Country:US
Mailing Address - Phone:304-777-9384
Mailing Address - Fax:
Practice Address - Street 1:5570 RICHMOND RD STE 203
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:VA
Practice Address - Zip Code:22974-4421
Practice Address - Country:US
Practice Address - Phone:304-777-9384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty