Provider Demographics
NPI:1831639178
Name:NEW BLOOM COUNSELING LLC
Entity Type:Organization
Organization Name:NEW BLOOM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAMON
Authorized Official - Suffix:
Authorized Official - Credentials:MED LPC
Authorized Official - Phone:470-776-0456
Mailing Address - Street 1:415 OAK HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-0820
Mailing Address - Country:US
Mailing Address - Phone:470-776-0456
Mailing Address - Fax:
Practice Address - Street 1:12700 CENTURY DR
Practice Address - Street 2:SUITE E
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8368
Practice Address - Country:US
Practice Address - Phone:470-776-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty