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General NPI Number Information
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NPI Number | 1801676473
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Entity Type | Organization
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Legal Business Name | BLOOM FAMILY THERAPIST GROUP, INC.
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 3511 CAMINO DEL RIO S STE 500
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City | SAN DIEGO
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State | CA
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Zip | 92108-4022
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Country | US
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Telephone | 619-500-1843
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1494
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City | IMPERIAL BEACH
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State | CA
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Zip | 91933-1494
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Country | US
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Telephone | 619-500-1843
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Fax |
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Authorized Official
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Title or Position | LICENSED THERAPIST / FOUNDER
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Name | ERICA TOPETE
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Credential | LMFT
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Telephone | 619-500-1843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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