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General NPI Number Information
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NPI Number | 1477419927
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Entity Type | Organization
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Legal Business Name | IN FULL BLOOM PSYCHOTHERAPY AND WELLNESS, LLC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 2129 18TH ST. SOUTH C/O
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City | BIRMINGHAM
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State | AL
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Zip | 35209
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Country | US
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Telephone | 215-421-2942
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Fax |
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Provider Business Mailing Address
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Address Line | 2810 N CHURCH ST # 947303
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City | WILMINGTON
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State | DE
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Zip | 19802-4447
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Country | US
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Telephone | 215-421-2942
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Fax |
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Authorized Official
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Title or Position | FOUNDER, EXECUTIVE DIRECTOR
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Name | MICHELLE LYNN DEAN
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Credential | MA, ATR-BC, LPC
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Telephone | 215-421-2942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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