Organization
BLOSSOM CHILD THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLEY COCK (MANAGER)
(704) 965-2142
Entity
Organization
Contact information
Practice address
107 N MAIN ST, DAVIDSON, NC 28036-9402
(704) 965-2142
Mailing address
430 DELBURG ST, DAVIDSON, NC 28036-6945
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/13/2023
Last updated
04/13/2023
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