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Organization
AWESOME BLOSSOM
Active
Organization
AWESOME BLOSSOM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEVTINA BASANTSOV BCBA (DIRECTOR)
(561) 543-0441
Entity
Organization
Contact information
Practice address
3438 FREEDOM DR, HOLLYWOOD, FL 33021-8451
(561) 543-0441
Mailing address
3438 FREEDOM DR, HOLLYWOOD, FL 33021-8451
(561) 543-0441
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
12/16/2024
Last updated
12/16/2024
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