Organization
THE RESILIENT BLOOM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY DUSEK LPC, LCMHC (MANAGER)
(704) 641-3824
Entity
Organization
Contact information
Practice address
1701 1ST BAXTER XING STE 201, FORT MILL, SC 29708-8980
(803) 542-9680
Mailing address
15812 WALNUT HILL DR, CHARLOTTE, NC 28278-5010
(704) 641-3824
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/23/2024
Last updated
03/04/2025
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