Healthcare Provider Details

I. General information

NPI: 1063206894
Provider Name (Legal Business Name): BUILD & BLOOM THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S BROAD ST
KENNETT SQUARE PA
19348-3320
US

IV. Provider business mailing address

421 S BROAD ST
KENNETT SQUARE PA
19348-3320
US

V. Phone/Fax

Practice location:
  • Phone: 215-821-9446
  • Fax:
Mailing address:
  • Phone: 215-821-9446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COREY WHITE
Title or Position: OWNER
Credential: MA, LPC
Phone: 302-584-7371