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General NPI Number Information
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NPI Number | 1932739166
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Entity Type | Organization
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Legal Business Name | BLOOM & BALANCE, PLLC
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Dates
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Enumeration Date | 01/15/2020
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 5 N LAFAYETTE ST STE 3
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City | SHELBY
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State | NC
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Zip | 28150-5687
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Country | US
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Telephone | 980-552-9374
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Fax | 980-552-9275
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Provider Business Mailing Address
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Address Line | 5 N LAFAYETTE ST STE 3
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City | SHELBY
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State | NC
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Zip | 28150-5687
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Country | US
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Telephone | 910-705-1698
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHTIN DICOCHEA
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Credential | LCSW
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Telephone | 910-705-1698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 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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