| Mind Bloom LLC | |
|
818 E Main St Ste A Spartanburg SC 29302-2000 | |
| (864) 274-3053 | |
| Not Available |
| Full Name | Mind Bloom LLC |
|---|---|
| Speciality | Social Worker |
| Location | 818 E Main St Ste A, Spartanburg, South Carolina |
| Authorized Official Name and Position | Andrea Ulloa (DIRECTOR) |
| Authorized Official Contact | 8642743053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Bloom LLC 818 E Main St Ste A Spartanburg SC 29302-2000 Ph: (864) 274-3053 | Mind Bloom LLC 818 E Main St Ste A Spartanburg SC 29302-2000 Ph: (864) 274-3053 |
| NPI Number | 1922988849 |
|---|---|
| Provider Enumeration Date | 09/03/2025 |
| Last Update Date | 09/03/2025 |
| Certification Date | 09/03/2025 |
| Medicare PECOS PAC ID | 0244720480 |
|---|---|
| Medicare Enrollment ID | O20251106003126 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922988849 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | () | Primary |
| Provider Name | Andrea S Ulloa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598428781 PECOS PAC ID: 1153811393 Enrollment ID: I20251106003423 |
| Provider Name | Jocelin E Hughes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609509603 PECOS PAC ID: 1355831082 Enrollment ID: I20251110002868 |
| Provider Name | Kristin S Faulkner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619155793 PECOS PAC ID: 0840786869 Enrollment ID: I20251230000483 |
| Provider Name | Ashton Vaughan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588528368 PECOS PAC ID: 1557849106 Enrollment ID: I20260204000474 |
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