Individual
DR. AUDREY BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
10475 MEDLOCK BRIDGE RD, BUILDING 300, SUITE 315, DULUTH, GA 30097-2002
(678) 935-9567
(678) 935-9568
Mailing address
9555 FENBROOK CT, ALPHARETTA, GA 30022-5106
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY001866
GA
Other
Enumeration date
11/06/2006
Last updated
07/09/2007
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