# BLOSSOM COMMUNITY SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** blossom community services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679125850
- **Authorized official:** MRS. LESLIE DANIELLE DUNBAR PEER SUPPORT. (CERTIFIED SUBTANCE ABUSE CONSERLOR)
- **Authorized official phone:** (704) 780-3082

## Contact information

- **Practice address:** 3134 AUTEN AVE, CHARLOTTE, NC 28269-4599
- **Practice address phone:** (704) 780-3082
- **Mailing address:** 3134 AUTEN AVE, CHARLOTTE, NC 28269-4599
- **Mailing address phone:** (704) 780-3082

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 225XM0800X | Mental Health Occupational Therapist | — | NULL | — |
| 225XM0800X | Mental Health Occupational Therapist | — | — | — |

## Other

- **Enumeration date:** 07/09/2019
- **Last updated:** 07/09/2019