Provider Demographics
NPI:1104053008
Name:IN BLOOM BEHAVIORAL HEALTH CARE
Entity type:Organization
Organization Name:IN BLOOM BEHAVIORAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:PACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-887-2847
Mailing Address - Street 1:15 TERRY CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2568
Mailing Address - Country:US
Mailing Address - Phone:540-887-2847
Mailing Address - Fax:540-887-2848
Practice Address - Street 1:15 TERRY CT
Practice Address - Street 2:SUITE D
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2568
Practice Address - Country:US
Practice Address - Phone:540-887-2847
Practice Address - Fax:540-887-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000751103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty