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General NPI Number Information
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NPI Number | 1922988849
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Entity Type | Organization
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Legal Business Name | MIND BLOOM LLC
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 818 E MAIN ST STE A
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City | SPARTANBURG
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State | SC
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Zip | 29302-2000
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Country | US
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Telephone | 864-274-3053
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Fax |
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Provider Business Mailing Address
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Address Line | 818 E MAIN ST STE A
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City | SPARTANBURG
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State | SC
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Zip | 29302-2000
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Country | US
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Telephone | 864-274-3053
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. ANDREA ULLOA
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Credential | LMSW
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Telephone | 864-274-3053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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