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General NPI Number Information
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NPI Number | 1003191321
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Entity Type | Organization
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Legal Business Name | TORUS BLOOM, LLC
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 10/18/2011
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Provider Practice Location Address
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Address Line | 100 WELLS ST SUITE 1A
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City | HARTFORD
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State | CT
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Zip | 06103-2928
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Country | US
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Telephone | 860-266-6238
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Fax |
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Provider Business Mailing Address
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Address Line | 100 WELLS ST SUITE 1A
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City | HARTFORD
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State | CT
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Zip | 06103-2928
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Country | US
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Telephone | 860-266-6238
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. DAUNE ALEXANDRIA KEMP
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Credential | LPC
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Telephone | 860-266-6238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001181
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License Number State | CT
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