Provider Demographics
NPI:1962378729
Name:BLOOM IN WELLNESS LLC
Entity type:Organization
Organization Name:BLOOM IN WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELSI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-922-2650
Mailing Address - Street 1:5012 BURTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-6010
Mailing Address - Country:US
Mailing Address - Phone:804-922-2650
Mailing Address - Fax:
Practice Address - Street 1:5012 BURTWOOD LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-6010
Practice Address - Country:US
Practice Address - Phone:804-922-2650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty