Provider Demographics
NPI:1861805806
Name:BLUE RIDGE COUNSELING CENTER, P.A.
Entity type:Organization
Organization Name:BLUE RIDGE COUNSELING CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LADC, CCS
Authorized Official - Phone:207-645-9770
Mailing Address - Street 1:32 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-1244
Mailing Address - Country:US
Mailing Address - Phone:207-645-9770
Mailing Address - Fax:207-897-9000
Practice Address - Street 1:32 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1244
Practice Address - Country:US
Practice Address - Phone:207-645-9770
Practice Address - Fax:207-897-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-07
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME683580261QM0801X
ME683579261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)