Provider Demographics
NPI:1992981070
Name:BLUE RIDGE WELLNESS CENTER LTD
Entity type:Organization
Organization Name:BLUE RIDGE WELLNESS CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:LUMSDEN
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:276-666-2605
Mailing Address - Street 1:325 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2928
Mailing Address - Country:US
Mailing Address - Phone:276-666-2605
Mailing Address - Fax:276-632-2991
Practice Address - Street 1:325 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2928
Practice Address - Country:US
Practice Address - Phone:276-666-2605
Practice Address - Fax:276-632-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040004801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO9081Medicare PIN