Organization
BLOSSOM COMMUNITY FOUNDATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE D DUNBAR OWNER/ DIRECTOR (DIRECTOR)
(704) 780-3082
Entity
Organization
Contact information
Practice address
2311 ABERDEEN BLVD STE A, GASTONIA, NC 28054-0603
(170) 478-0308
Mailing address
2311 ABERDEEN BLVD STE A, GASTONIA, NC 28054-0603
(170) 478-0308
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103T00000X
Psychologist
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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