MEDICARE: BLOOM AND BLOSSOM COUNSELING SERVICES LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1649081795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM AND BLOSSOM COUNSELING SERVICES LLC.

Provider Business Mailing Address
First Line	:	4410 CLAIBORNE SQ E STE 218
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2071
Country	:	US
Telephone Number	:	757-553-5375
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 CLAIBORNE SQ E STE 218
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2071
Country	:	US
Telephone Number	:	609-949-2899
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JEYLIM WAYNE
Credential	:	LPC
Telephone Number	:	757-553-5375

Provider Enumeration Date	:	01/17/2025
Last Update Date	:	02/12/2026

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