Provider Demographics
NPI:1629953484
Name:BLOOMLIFE
Entity type:Organization
Organization Name:BLOOMLIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TINDLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LICSW
Authorized Official - Phone:301-356-1354
Mailing Address - Street 1:9315 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3974
Mailing Address - Country:US
Mailing Address - Phone:240-962-4140
Mailing Address - Fax:
Practice Address - Street 1:9315 CEDAR LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3974
Practice Address - Country:US
Practice Address - Phone:240-962-4140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty