Healthcare Provider Details

I. General information

NPI: 1770375206
Provider Name (Legal Business Name): SOLBLOOM MIND & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 FAIRMONT RD STE 201
MORGANTOWN WV
26501-3892
US

IV. Provider business mailing address

1280 FORMAN DR
MORGANTOWN WV
26508-8788
US

V. Phone/Fax

Practice location:
  • Phone: 304-278-6160
  • Fax: 304-278-6165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTIANNE S. CONNELLY
Title or Position: OWNER, EMPLOYEE
Credential: PHD
Phone: 304-278-6160