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General NPI Number Information
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NPI Number | 1629973797
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Entity Type | Organization
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Legal Business Name | MIND BLOOM COUNSELING SERVICES
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 4164 NUTTER FRK
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City | WEST UNION
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State | WV
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Zip | 26456-8317
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Country | US
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Telephone | 304-871-0084
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Fax |
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Provider Business Mailing Address
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Address Line | 4164 NUTTER FRK
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City | WEST UNION
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State | WV
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Zip | 26456-8317
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Country | US
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Telephone | 304-871-0084
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | LISA DIANNE BALL
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Credential | LPC
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Telephone | 304-871-0084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NULL
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