Healthcare Provider Details

I. General information

NPI: 1164379467
Provider Name (Legal Business Name): BLOOM & CO COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 N PARHAM RD STE 3207236
HENRICO VA
23294-4410
US

IV. Provider business mailing address

2807 N PARHAM RD STE 3207236
HENRICO VA
23294-4410
US

V. Phone/Fax

Practice location:
  • Phone: 804-590-5698
  • Fax: 804-590-5698
Mailing address:
  • Phone: 804-590-5698
  • Fax: 804-590-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. JALISSA BRANCH
Title or Position: QMHP
Credential: QMHP
Phone: 804-590-5698