Healthcare Provider Details

I. General information

NPI: 1861301400
Provider Name (Legal Business Name): EVERBLOOM BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 OAKDALE COMMONS CT
CHARLOTTE NC
28216-5811
US

IV. Provider business mailing address

1204 OAKDALE COMMONS CT
CHARLOTTE NC
28216-5811
US

V. Phone/Fax

Practice location:
  • Phone: 704-953-7937
  • Fax:
Mailing address:
  • Phone: 704-953-7937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAQUETA CROWDER
Title or Position: CO-OWNER
Credential: LCSWA
Phone: 704-953-7937