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General NPI Number Information
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NPI Number | 1679323794
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Entity Type | Organization
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Legal Business Name | BLOOM MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 03/22/2024
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 31 PINE GROVE RD # 1009
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City | LOCUST GROVE
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State | GA
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Zip | 30248-2561
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Country | US
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Telephone | 404-530-9252
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Fax |
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Provider Business Mailing Address
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Address Line | 31 PINE GROVE RD # 1009
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City | LOCUST GROVE
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State | GA
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Zip | 30248-2561
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | CIERRA BROWN
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Credential | LPC
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Telephone | 404-447-4327
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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 |
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