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General NPI Number Information
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NPI Number | 1154856078
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Entity Type | Organization
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Legal Business Name | IN BLOOM COUNSELING, LLC
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 22 PINE ST SUITE 205
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City | BRISTOL
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State | CT
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Zip | 06010-6948
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Country | US
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Telephone | 203-626-1605
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Fax |
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Provider Business Mailing Address
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Address Line | 22 PINE ST SUITE 205
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City | BRISTOL
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State | CT
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Zip | 06010-6948
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Country | US
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Telephone | 203-626-1605
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEANNA JOHNSON
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Credential |
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Telephone | 203-747-6980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1569
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License Number State | CT
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