Individual
LISA MAPLE BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC-I
Contact information
Practice address
916 N MAIN ST, LAS VEGAS, NV 89101-1931
(702) 202-6647
Mailing address
916 N MAIN ST, LAS VEGAS, NV 89101-1931
(702) 202-6647
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
08072-I
NV
Other
Enumeration date
07/09/2025
Last updated
07/09/2025
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