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General NPI Number Information
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NPI Number | 1174478721
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Entity Type | Organization
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Legal Business Name | JADE BLOOM PSYCHOEDUCATIONAL SERVICES LLC
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Dates
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Enumeration Date | 02/27/2026
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Last Update Date | 02/27/2026
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Provider Practice Location Address
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Address Line | 1 WINDSOR CV STE 105
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City | COLUMBIA
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State | SC
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Zip | 29223-1833
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Country | US
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Telephone | 803-766-6766
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Fax |
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Provider Business Mailing Address
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Address Line | 388 LONGFELLOWS LN
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City | ELGIN
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State | SC
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Zip | 29045-7126
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Country | US
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Telephone | 803-766-6766
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Fax |
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Authorized Official
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Title or Position | SCHOOL PSYCHOLOGIST/LPES
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Name | DAPHANE GRACE RIVERS
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Credential | SSP, NCSP, LPES
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Telephone | 678-492-6073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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