Provider Demographics
NPI:1457939985
Name:MAGNOLIA BLOOM COUNSELING, LLC
Entity Type:Organization
Organization Name:MAGNOLIA BLOOM COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOINER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:228-224-0984
Mailing Address - Street 1:11079 OAKCREST DR
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-2368
Mailing Address - Country:US
Mailing Address - Phone:228-224-0984
Mailing Address - Fax:
Practice Address - Street 1:4063 GINGER DR STE D
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-3705
Practice Address - Country:US
Practice Address - Phone:985-250-1614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty