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General NPI Number Information
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NPI Number | 1942883905
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Entity Type | Organization
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Legal Business Name | ETERNAL BLISS, LLC
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 10/23/2021
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Provider Practice Location Address
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Address Line | 4500 MERCANTILE PLAZA DR STE 300
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City | FORT WORTH
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State | TX
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Zip | 76137-4206
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Country | US
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Telephone | 817-476-0317
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Fax |
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Provider Business Mailing Address
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Address Line | 4204 BENT OAKS DR
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City | ARLINGTON
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State | TX
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Zip | 76001-5157
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Country | US
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Telephone | 817-476-0317
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAQUINDRA CARROLL
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Credential | LCSW
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Telephone | 817-476-0317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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