Provider Demographics
NPI:1891562922
Name:LIFE IN BLOOM COUNSELING, LLC
Entity type:Organization
Organization Name:LIFE IN BLOOM COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FABIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAIVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-932-5190
Mailing Address - Street 1:105 BLACKSTONE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-6612
Mailing Address - Country:US
Mailing Address - Phone:818-932-5190
Mailing Address - Fax:
Practice Address - Street 1:20 FOUNDRY ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5419
Practice Address - Country:US
Practice Address - Phone:603-232-9246
Practice Address - Fax:603-232-9246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)