Provider Demographics
NPI:1770375206
Name:SOLBLOOM MIND & WELLNESS, PLLC
Entity type:Organization
Organization Name:SOLBLOOM MIND & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-278-6160
Mailing Address - Street 1:1280 FORMAN DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8788
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:829 FAIRMONT RD STE 201
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-3892
Practice Address - Country:US
Practice Address - Phone:304-278-6160
Practice Address - Fax:304-278-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty