Provider Demographics
NPI:1174321541
Name:SOUL BLOOM COUNSELING, LLC
Entity type:Organization
Organization Name:SOUL BLOOM COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VALENCIA
Authorized Official - Middle Name:RASHAUN
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-648-0811
Mailing Address - Street 1:1100 INDIAN TRAIL LILBURN RD APT 821
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-4573
Mailing Address - Country:US
Mailing Address - Phone:470-648-0811
Mailing Address - Fax:
Practice Address - Street 1:1100 INDIAN TRAIL LILBURN RD APT 821
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-4573
Practice Address - Country:US
Practice Address - Phone:470-648-0811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health