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General NPI Number Information
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NPI Number | 1700782331
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Entity Type | Organization
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Legal Business Name | BLOOM THERAPY COLLECTIVE LLC
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Dates
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Enumeration Date | 10/19/2026
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Last Update Date | 10/19/2026
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Provider Practice Location Address
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Address Line | 200 MAIN ST UNIT 2
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City | WEAVER
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State | AL
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Zip | 36277-3802
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Country | US
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Telephone | 256-689-6331
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Fax |
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Provider Business Mailing Address
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Address Line | 40 JIM ANGEL DR
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City | JACKSONVILLE
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State | AL
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Zip | 36265-6093
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Country | US
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Telephone | 256-689-6331
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. BRIDGETTE MARIE WILSON
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Credential | LICSW-S, PIP, RPT
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Telephone | 256-689-6331
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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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