Basic Information
| Provider Information | |||||||||
| NPI: | 1568989291 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLOOM COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 HARDIN OAK DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357563974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077390107 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4800 WHITESPORT CIR SW STE 2 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358016443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565339393 | ||||||||
| FaxNumber: | 2565339690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2017 | ||||||||
| LastUpdateDate: | 08/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | DILEONE-HUFF | ||||||||
| AuthorizedOfficialFirstName: | LOUISA | ||||||||
| AuthorizedOfficialMiddleName: | NUNZIA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PROFESSIONAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 4077390107 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 3117 | AL | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.