Organization
BLOSSOM COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AIYANA SMITH (OWENR)
(631) 343-5634
Entity
Organization
Contact information
Practice address
61 MAIN ST, SOUTHAMPTON, NY 11968-4870
(631) 343-5634
Mailing address
26 HILL ST STE 114, SOUTHAMPTON, NY 11968-5317
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/17/2019
Last updated
05/30/2024
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