34D0949052 CLIA NUMBER - BLUE RIDGE MEDICAL GROUP PA

Laboratory Demographics

CLIA Number: 34D0949052

Facility Name: BLUE RIDGE MEDICAL GROUP PA

Facility Address:
3214 CHARLES B ROOT WYND STE 217
RALEIGH, NC
ZIP 27612
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Facility Phone Number: 919 789-9168

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1851482434

Taxonomy: 103TC0700X - Psychologist
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

CLIA Record

Field Name	Field Value
CLIA Number	34D0949052
LAB Type	Physician Office
Facility Name	BLUE RIDGE MEDICAL GROUP PA
Street	3214 CHARLES B ROOT WYND STE 217
City	RALEIGH
State	NC
ZIP	27612
Phone	919 789-9168
CertificateType	3
CertificateEffectiveDate	7/24/2022
CertificateExpirationDate	7/23/2024
FacilityType	PPMP

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This page was last updated on: 4/23/2024