Healthcare Provider Details

I. General information

NPI: 1720919699
Provider Name (Legal Business Name): BLOOMING FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E MAIN ST STE 1600-110
NORFOLK VA
23510-2205
US

IV. Provider business mailing address

11312 LUDGATE PL
CHESTER VA
23831-1878
US

V. Phone/Fax

Practice location:
  • Phone: 804-709-5002
  • Fax:
Mailing address:
  • Phone: 804-709-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: OYEWALE OLU OYEWOLE
Title or Position: CEO
Credential: MD
Phone: 804-709-5002