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General NPI Number Information
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NPI Number | 1467075713
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Entity Type | Organization
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Legal Business Name | BLOSSOM AND GROW WELLNESS CENTER
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 9250 RUMSEY RD STE 201
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City | COLUMBIA
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State | MD
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Zip | 21045-2019
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Country | US
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Telephone | 240-887-8071
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Fax |
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Provider Business Mailing Address
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Address Line | 2917 SILVER HILL AVE
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City | GWYNN OAK
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State | MD
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Zip | 21207-6855
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Country | US
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Telephone | 203-908-5331
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY KANSINALLY
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Credential | LCSW-C
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Telephone | 203-908-5331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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