Healthcare Provider Details

I. General information

NPI: 1780568543
Provider Name (Legal Business Name): RISE AND BLOOM COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 CARTER RIDGE RD
WESTMORELAND TN
37186-5111
US

IV. Provider business mailing address

212 CARTER RIDGE RD
WESTMORELAND TN
37186-5111
US

V. Phone/Fax

Practice location:
  • Phone: 404-428-1765
  • Fax:
Mailing address:
  • Phone: 404-428-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA L HURST
Title or Position: OWNER
Credential: MS, NCC, LPC-MHSP
Phone: 423-521-2024