Provider Demographics
NPI:1720698939
Name:BLUE RIDGE BEHAVIOR SYSTEMS INC
Entity type:Organization
Organization Name:BLUE RIDGE BEHAVIOR SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-540-4291
Mailing Address - Street 1:16426 HAWFIELD WOODS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6108
Mailing Address - Country:US
Mailing Address - Phone:704-540-4291
Mailing Address - Fax:704-541-0319
Practice Address - Street 1:16147 LANCASTER HWY STE 110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4196
Practice Address - Country:US
Practice Address - Phone:704-540-4291
Practice Address - Fax:704-541-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty