Healthcare Provider Details

I. General information

NPI: 1124959937
Provider Name (Legal Business Name): BLOOMSTEAD COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20901 TORRENCE CHAPEL RD STE 102B
CORNELIUS NC
28031-6397
US

IV. Provider business mailing address

9725 DALPHON JONES DR
CHARLOTTE NC
28213-7794
US

V. Phone/Fax

Practice location:
  • Phone: 980-288-5521
  • Fax:
Mailing address:
  • Phone: 980-288-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MEGAN DRAUGHN ANGUIANO
Title or Position: OWNER, THERAPIST
Credential:
Phone: 336-749-1321