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General NPI Number Information
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NPI Number | 1972257772
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Entity Type | Organization
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Legal Business Name | BEAUTIFUL BLOOM COUNSELING & CONSULTING LLC
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 3485 MCEVER RD STE 205
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City | GAINESVILLE
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State | GA
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Zip | 30504-5542
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Country | US
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Telephone | 770-450-9900
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Fax | 770-450-9300
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Provider Business Mailing Address
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Address Line | 3485 MCEVER RD STE 205
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City | GAINESVILLE
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State | GA
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Zip | 30504-5542
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Country | US
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Telephone | 770-450-9900
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Fax | 770-450-9300
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | KELLEY DODSON
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Credential | LPC, CPCS
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Telephone | 770-262-1311
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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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