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General NPI Number Information
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NPI Number | 1770375206
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Entity Type | Organization
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Legal Business Name | SOLBLOOM MIND & WELLNESS, PLLC
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 829 FAIRMONT RD STE 201
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City | MORGANTOWN
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State | WV
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Zip | 26501-3892
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Country | US
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Telephone | 304-278-6160
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Fax | 304-278-6165
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Provider Business Mailing Address
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Address Line | 1280 FORMAN DR
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City | MORGANTOWN
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State | WV
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Zip | 26508-8788
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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, EMPLOYEE
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Name | DR. CHRISTIANNE S. CONNELLY
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Credential | PHD
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Telephone | 304-278-6160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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