Healthcare Provider Details

I. General information

NPI: 1649197617
Provider Name (Legal Business Name): BLOOM WITHIN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HARVEST DR
SPRINGFIELD GA
31329-4228
US

IV. Provider business mailing address

113 HARVEST DR
SPRINGFIELD GA
31329-4228
US

V. Phone/Fax

Practice location:
  • Phone: 912-655-0955
  • Fax:
Mailing address:
  • Phone: 912-655-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CAITLAN DESIMAS
Title or Position: OWNER
Credential:
Phone: 912-655-0955