Organization
BLOSSOM COMMUNITY SERVICES
Active
Other names
Blossom Community Services Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LESLIE DANIELLE DUNBAR (OWNER)
(704) 780-3082
Entity
Organization
Contact information
Practice address
1911 WILLIMAX AVE, GASTONIA, NC 28054-7440
(704) 780-3082
Mailing address
1911 WILLIMAX AVENUE, GASTONIA, NC 28054-7440
(704) 780-3082
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
343800000X
Secured Medical Transport (VAN)
—
—
344600000X
Taxi
—
—
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447734181
—
NC
Enumeration date
09/19/2018
Last updated
12/10/2024
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