Healthcare Provider Details

I. General information

NPI: 1366370264
Provider Name (Legal Business Name): CAROLINA BLOOMS EARLY INTERVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 CELEBRATION BLVD
FLORENCE SC
29501-5499
US

IV. Provider business mailing address

1245 CELEBRATION BLVD
FLORENCE SC
29501-5499
US

V. Phone/Fax

Practice location:
  • Phone: 864-584-8315
  • Fax: 864-551-2758
Mailing address:
  • Phone: 864-584-8315
  • Fax: 864-551-2758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRELL TENNIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-217-0933