Provider Demographics
NPI:1194468025
Name:BLOSSOM BEHAVIORAL SOLUTIONS, LLC
Entity type:Organization
Organization Name:BLOSSOM BEHAVIORAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:704-586-9581
Mailing Address - Street 1:150 THOMAS DR STE 124
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708
Mailing Address - Country:US
Mailing Address - Phone:704-586-9581
Mailing Address - Fax:
Practice Address - Street 1:150 BW THOMAS DR STE 124
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7237
Practice Address - Country:US
Practice Address - Phone:704-586-9581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty