Healthcare Provider Details

I. General information

NPI: 1710844048
Provider Name (Legal Business Name): NEUROBLOOM COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12305 KENDALL RIDGE CT
DURHAM NC
27703-8541
US

IV. Provider business mailing address

12305 KENDALL RIDGE CT
DURHAM NC
27703-8541
US

V. Phone/Fax

Practice location:
  • Phone: 919-537-9763
  • Fax:
Mailing address:
  • Phone: 919-537-9763
  • 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: STEPHENS CHERRY
Title or Position: PRACTICE OWNER
Credential: MS, CRC, LCMHC
Phone: 910-619-9757