Healthcare Provider Details

I. General information

NPI: 1023873833
Provider Name (Legal Business Name): BLOOM AND GROW COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9786 TIMBER CIR STE A
SPANISH FORT AL
36527-5460
US

IV. Provider business mailing address

9786 TIMBER CIR STE A
SPANISH FORT AL
36527-5460
US

V. Phone/Fax

Practice location:
  • Phone: 251-298-8485
  • Fax:
Mailing address:
  • Phone: 251-298-8485
  • 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: LAURA WIGGINS ANDERSON
Title or Position: OWNER
Credential: LPC
Phone: 251-298-8485