Provider Demographics
NPI:1205500477
Name:BLOOM IN SESSION PSYCHOTHERAPY & CONSULTING, LLC
Entity type:Organization
Organization Name:BLOOM IN SESSION PSYCHOTHERAPY & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAREKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE-ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-264-1069
Mailing Address - Street 1:9 WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303
Mailing Address - Country:US
Mailing Address - Phone:318-264-1069
Mailing Address - Fax:318-314-3011
Practice Address - Street 1:3600 JACKSON ST STE 113A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3040
Practice Address - Country:US
Practice Address - Phone:318-442-5465
Practice Address - Fax:318-314-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty