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General NPI Number Information
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NPI Number | 1851042766
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Entity Type | Organization
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Legal Business Name | BLOOM MENTAL HEALTH FOUNDATION
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1307 JAMESTOWN RD STE 201
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-3392
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Country | US
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Telephone | 757-912-0010
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Fax | 757-578-9119
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Provider Business Mailing Address
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Address Line | 1307 JAMESTOWN RD STE 201
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-3392
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Country | US
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Telephone | 757-912-0010
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Fax | 757-578-9119
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | MRS. CARLI PAPAS-PASCO
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Credential | LCSW
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Telephone | 757-912-0010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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