Healthcare Provider Details

I. General information

NPI: 1205587797
Provider Name (Legal Business Name): FULL BLOOM COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2022
Last Update Date: 01/16/2022
Certification Date: 01/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 STONEMILL WAY
SWEDESBORO NJ
08085-1861
US

IV. Provider business mailing address

PO BOX 372
PENNSVILLE NJ
08070-0372
US

V. Phone/Fax

Practice location:
  • Phone: 609-202-1107
  • Fax:
Mailing address:
  • Phone: 609-202-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: REBECCA LAFLEUR
Title or Position: OWNER/ COUNSELOR
Credential: LPC, ACS
Phone: 609-202-1107