Organization
SOUL BLOOM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TENISHA NAOMI TOLEN (CEO)
(301) 714-8359
Entity
Organization
Contact information
Practice address
10779 KITCHENER CT, BOWIE, MD 20721-1854
(301) 714-8359
Mailing address
10779 KITCHENER CT, BOWIE, MD 20721-1854
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
04/22/2022
Last updated
04/22/2022
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