Healthcare Provider Details

I. General information

NPI: 1265350318
Provider Name (Legal Business Name): BLISS INTEGRATIVE HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3104 SEMMES AVE
RICHMOND VA
23225-3759
US

IV. Provider business mailing address

3104 SEMMES AVE
RICHMOND VA
23225-3759
US

V. Phone/Fax

Practice location:
  • Phone: 804-571-7315
  • Fax:
Mailing address:
  • Phone: 804-571-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE BOONE
Title or Position: CEO
Credential: MSN, AGACNP, PMHNP
Phone: 804-847-0765