Healthcare Provider Details

I. General information

NPI: 1417878653
Provider Name (Legal Business Name): THERAPY BLOOMS WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 KELLEY ST STE 200
LAKE CITY SC
29560-2472
US

IV. Provider business mailing address

141 ORCHARD PARK RD
COLUMBIA SC
29223-7799
US

V. Phone/Fax

Practice location:
  • Phone: 803-309-2381
  • Fax:
Mailing address:
  • Phone: 803-309-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CYNTHIA WALLACE MCFADDEN
Title or Position: OWNER
Credential: DHSC
Phone: 803-309-2381