# BLOSSOM INTEGRATED HEALTH AND BEHAVIORAL SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003653783
- **Authorized official:** IHUOMA MARVELOUS UDEAGHA DNP (PMHNP)
- **Authorized official phone:** (240) 347-4497

## Contact information

- **Practice address:** 338 MILL ST, HAGERSTOWN, MD 21740-6138
- **Practice address phone:** (240) 347-4494
- **Mailing address:** 338 MILL ST, HAGERSTOWN, MD 21740-6138
- **Mailing address phone:** (240) 347-4494

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/10/2024
- **Last updated:** 07/10/2024