Healthcare Provider Details

I. General information

NPI: 1932029857
Provider Name (Legal Business Name): WILLOW BLOOM COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28119 N MAIN ST STE D
DAPHNE AL
36526-7090
US

IV. Provider business mailing address

25723 TEALWOOD DR
DAPHNE AL
36526-6472
US

V. Phone/Fax

Practice location:
  • Phone: 251-680-2224
  • Fax:
Mailing address:
  • Phone: 251-680-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHELCEY GIBSON
Title or Position: OWNER
Credential: MS, LPC, NCC
Phone: 251-680-2224