Healthcare Provider Details

I. General information

NPI: 1104798040
Provider Name (Legal Business Name): BLOOMING ROADS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2025
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 TRAPPER SPRINGS LN
DRUMS PA
18222-1219
US

IV. Provider business mailing address

213 TRAPPER SPRINGS LN
DRUMS PA
18222-1219
US

V. Phone/Fax

Practice location:
  • Phone: 570-519-8818
  • Fax: 570-990-3029
Mailing address:
  • Phone: 570-519-8818
  • Fax: 570-990-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LISA MARIE MEDVETZ
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 724-699-1419