Provider Demographics
NPI:1992074561
Name:BLUE RIDGE TREKS
Entity type:Organization
Organization Name:BLUE RIDGE TREKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PEELE
Authorized Official - Last Name:EARLY
Authorized Official - Suffix:II
Authorized Official - Credentials:LCSW
Authorized Official - Phone:828-707-5751
Mailing Address - Street 1:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-0865
Mailing Address - Country:US
Mailing Address - Phone:828-707-5751
Mailing Address - Fax:
Practice Address - Street 1:70 WOODFIN PL
Practice Address - Street 2:SUITE 417
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2463
Practice Address - Country:US
Practice Address - Phone:828-707-5751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC007435251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health