Healthcare Provider Details

I. General information

NPI: 1659214955
Provider Name (Legal Business Name): SAGE AND BLOOM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5004 S U ST STE 203
FORT SMITH AR
72903-3600
US

IV. Provider business mailing address

5004 S U ST STE 203
FORT SMITH AR
72903-3600
US

V. Phone/Fax

Practice location:
  • Phone: 479-384-5958
  • Fax:
Mailing address:
  • Phone: 479-384-5958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GEORGIANA L ROBINSON
Title or Position: OWNER/ THERAPIST
Credential: LCSW
Phone: 209-857-1737