Organization
BLUE RIDGE PSYCHOLOGICAL SERVICES, LLC
Active
Organization
BLUE RIDGE PSYCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DAVID RAQUE PSYD (REGISTERED AGENT/OWNER)
(706) 455-2490
Entity
Organization
Contact information
Practice address
9757 BLUE RIDGE DR, BLUE RIDGE, GA 30513-4167
(706) 455-2490
(706) 946-6574
Mailing address
9757 BLUE RIDGE DR, BLUE RIDGE, GA 30513-4167
(706) 455-2490
(706) 946-6574
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY003039
GA
Other
Enumeration date
04/06/2009
Last updated
01/31/2025
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