Healthcare Provider Details

I. General information

NPI: 1033023262
Provider Name (Legal Business Name): INDIGO BLOOM THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 LITTLE FALLS ST STE 206
FALLS CHURCH VA
22046-4323
US

IV. Provider business mailing address

140 LITTLE FALLS ST STE 206
FALLS CHURCH VA
22046-4323
US

V. Phone/Fax

Practice location:
  • Phone: 703-993-0589
  • Fax:
Mailing address:
  • Phone: 703-993-0589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SHARITA VIVIAN CRAWFORD
Title or Position: OWNER
Credential: LCSW
Phone: 703-993-0589