Provider Demographics
NPI:1811319429
Name:BLISS, LEHOME' (PHD)
Entity type:Individual
Prefix:DR
First Name:LEHOME'
Middle Name:
Last Name:BLISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N 85 PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4003
Mailing Address - Country:US
Mailing Address - Phone:678-522-5361
Mailing Address - Fax:678-522-5361
Practice Address - Street 1:109 N 85 PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4003
Practice Address - Country:US
Practice Address - Phone:678-522-5361
Practice Address - Fax:678-522-5361
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170724101Y00000X
GA2009170101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral