Provider Demographics
NPI:1760059380
Name:BLOOM COUNSELING SERVICES
Entity Type:Organization
Organization Name:BLOOM COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-255-0646
Mailing Address - Street 1:1697 OAKBROOK LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1755
Mailing Address - Country:US
Mailing Address - Phone:773-255-0646
Mailing Address - Fax:
Practice Address - Street 1:1697 OAKBROOK LAKE DR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1755
Practice Address - Country:US
Practice Address - Phone:773-255-0646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health