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General NPI Number Information
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NPI Number | 1427917251
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Entity Type | Organization
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Legal Business Name | BLISS BOUTIQUE 360 INC.
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Dates
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Enumeration Date | 01/19/2026
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 3300 HIGHWAY 166
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-5108
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Country | US
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Telephone | 770-827-6397
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 HIGHWAY 166
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-5108
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Country | US
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Telephone | 770-827-6397
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. SHAQUITA GRAHAM
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Credential |
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Telephone | 216-235-9063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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