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General NPI Number Information
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NPI Number | 1447134853
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Entity Type | Organization
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Legal Business Name | BOND & BLOOM
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 1641 MASSEY CIR
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City | CHARLESTON
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State | WV
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Zip | 25303-2616
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Country | US
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Telephone | 864-251-5171
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Fax |
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Provider Business Mailing Address
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Address Line | 1641 MASSEY CIR
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City | CHARLESTON
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State | WV
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Zip | 25303-2616
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Country | US
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Telephone | 864-251-5171
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | AUTUMN WILLIAMSON
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Credential | LICSW, LISW-CP
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Telephone | 864-251-5171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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