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Organization
PHOENIX BLOOM THERAPEUTICS, LLC
Active
Organization
PHOENIX BLOOM THERAPEUTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TINA NICHOLE HACKER IMFT, LMFT, LICDC, (OWNER)
(859) 307-4540
Entity
Organization
Contact information
Practice address
31 HIDEAWAY DR, COVINGTON, KY 41017-9775
(859) 307-4540
Mailing address
31 HIDEAWAY DR, COVINGTON, KY 41017-9775
(859) 307-4540
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
09/14/2026
Last updated
09/14/2026
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