Healthcare Provider Details

I. General information

NPI: 1891562922
Provider Name (Legal Business Name): LIFE IN BLOOM COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 FOUNDRY ST
CONCORD NH
03301-5419
US

IV. Provider business mailing address

105 BLACKSTONE ST
MANCHESTER NH
03103-6612
US

V. Phone/Fax

Practice location:
  • Phone: 603-232-9246
  • Fax: 603-232-9246
Mailing address:
  • Phone: 818-932-5190
  • 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: FABIOLA PAIVA
Title or Position: CEO
Credential:
Phone: 818-932-5190