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General NPI Number Information
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NPI Number | 1699578112
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Entity Type | Organization
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Legal Business Name | BLOSSOM IN UNITY, LLC
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 1012 SW KING AVE
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City | PORTLAND
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State | OR
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Zip | 97205-1106
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Country | US
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Telephone | 503-410-4475
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Fax | 877-744-1853
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Provider Business Mailing Address
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Address Line | 6835 NE 13TH AVE
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City | PORTLAND
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State | OR
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Zip | 97211-4020
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Country | US
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Telephone | 503-410-4475
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Fax | 877-744-1853
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Authorized Official
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Title or Position | OPERATOR OWNER
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Name | LUCRECIA V. SUAREZ
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Credential | LCSW
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Telephone | 503-410-4475
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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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