Healthcare Provider Details

I. General information

NPI: 1992304554
Provider Name (Legal Business Name): BLOSSOMING MINDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4724 VINE ST
CINCINNATI OH
45217-1254
US

IV. Provider business mailing address

4724 VINE ST
CINCINNATI OH
45217-1254
US

V. Phone/Fax

Practice location:
  • Phone: 513-642-9951
  • Fax:
Mailing address:
  • Phone: 513-642-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. KESHA BLUNT WILLIAMS
Title or Position: CEO
Credential: PHD, LSW, LCDCIII
Phone: 513-642-9951