Provider Demographics
NPI:1528565454
Name:LOTUS BLOSSOM COUNSELING LLC
Entity Type:Organization
Organization Name:LOTUS BLOSSOM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:860-539-2242
Mailing Address - Street 1:15 UNDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1251
Mailing Address - Country:US
Mailing Address - Phone:860-539-2242
Mailing Address - Fax:
Practice Address - Street 1:152 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1020
Practice Address - Country:US
Practice Address - Phone:860-539-2242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1184281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty