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Organization
BLOSSOM PROFESSIONAL CLINICAL COUNSELOR SERVICES, INC.
Active
Organization
BLOSSOM PROFESSIONAL CLINICAL COUNSELOR SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAXINE DEFANK MA, LPCC (OWNER)
(850) 564-6130
Entity
Organization
Contact information
Practice address
201 LOMAS SANTA FE DR STE 490, SOLANA BEACH, CA 92075-1287
(619) 333-8597
Mailing address
201 LOMAS SANTA FE DR STE 490, SOLANA BEACH, CA 92075-1287
(619) 333-8597
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/23/2026
Last updated
07/29/2026
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