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General NPI Number Information
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NPI Number | 1497479315
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Entity Type | Organization
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Legal Business Name | BLOOM THERAPY LLC
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 1259 MONROE DR NE
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City | ATLANTA
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State | GA
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Zip | 30306-3439
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Country | US
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Telephone | 404-836-0844
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Fax |
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Provider Business Mailing Address
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Address Line | 2036 DELANO DR NE
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City | ATLANTA
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State | GA
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Zip | 30317-1237
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Country | US
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Telephone | 404-836-0844
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | LINDSEY GALINIS
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Credential |
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Telephone | 404-836-0844
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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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