Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 10301 | TX |
NPI | 1003093584 |
---|---|
Provider Name | Ms. Virginia Adams Bloom |
First Address | Austin, TX 78704-3061 |
Second Address | Austin, TX 78704-3061 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2008 |
Last Update Date | 27/01/2008 |