Organization
BLOOM ABA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BREANNAH DAVIS-BLOOM EDD (OWNER OPERATOR)
(336) 918-6033
Entity
Organization
Contact information
Practice address
409 CLARINE DR, GOOSE CREEK, SC 29445-3628
(336) 918-6033
Mailing address
78 FOLLY ROAD BLVD STE B9, CHARLESTON, SC 29407-7551
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/11/2023
Last updated
05/11/2023
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