Provider Demographics
NPI:1699412296
Name:BLOSSOM COUNSELING AND WELLNESS LLC
Entity Type:Organization
Organization Name:BLOSSOM COUNSELING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-486-0321
Mailing Address - Street 1:322 MORLYN DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENSON
Mailing Address - State:VA
Mailing Address - Zip Code:22656-2221
Mailing Address - Country:US
Mailing Address - Phone:540-486-0321
Mailing Address - Fax:
Practice Address - Street 1:149B CREEKSIDE LN
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-2447
Practice Address - Country:US
Practice Address - Phone:540-486-0321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932783198OtherNPI