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General NPI Number Information
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NPI Number | 1215547831
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Entity Type | Organization
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Legal Business Name | IN BLOOM MENTAL HEALTH COUNSELING, LLC
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Dates
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Enumeration Date | 08/07/2020
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 247 PROSPECT AVE STE 4H
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City | BROOKLYN
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State | NY
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Zip | 11215-8403
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Country | US
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Telephone | 347-509-7127
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Fax |
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Provider Business Mailing Address
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Address Line | 2324 W JOPPA RD STE 410
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4620
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Country | US
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Telephone | 443-446-4718
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Fax | 347-391-0191
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Authorized Official
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Title or Position | OWNER
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Name | SHANDELLE HETHER-GRAY
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Credential | LMHC, LCPC
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Telephone | 347-509-7127
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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 |
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License Number State |
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