MEDICARE: BLOOM & CO COUNSELING AND CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164379467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM & CO COUNSELING AND CONSULTING LLC

Provider Business Mailing Address
First Line	:	2807 N PARHAM RD STE 3207236
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4410
Country	:	US
Telephone Number	:	804-590-5698
Fax Number	:	804-590-5698

Provider Business Practice Location Address
First Line	:	2807 N PARHAM RD STE 3207236
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4410
Country	:	US
Telephone Number	:	804-590-5698
Fax Number	:	804-590-5698

Authorized Official
Title or Position	:	QMHP
Name	:	MS. JALISSA BRANCH
Credential	:	QMHP
Telephone Number	:	804-590-5698

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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