Healthcare Provider Details

I. General information

NPI: 1225735749
Provider Name (Legal Business Name): EVER BLOOMING THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 JOSEPH AVE
WILLIAMSON WV
25661-3306
US

IV. Provider business mailing address

PO BOX 2274
WILLIAMSON WV
25661-2274
US

V. Phone/Fax

Practice location:
  • Phone: 304-785-9815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARISSA SIETSEMA
Title or Position: OWNER
Credential: MSW
Phone: 304-785-0815