Organization
FULL BLOOM THERAPY & CONSULTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY MICHELLE JENKINS LCPC (OWNER)
(207) 837-6599
Entity
Organization
Contact information
Practice address
9 BOWDOIN MILL IS, TOPSHAM, ME 04086-1263
(207) 837-6599
Mailing address
9 BOWDOIN MILL IS, TOPSHAM, ME 04086-1263
(207) 837-6599
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780018119
—
ME
Enumeration date
02/14/2019
Last updated
11/05/2023
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