Healthcare Provider Details

I. General information

NPI: 1255244679
Provider Name (Legal Business Name): TATYANA BLOOMFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 EUGENE CT
GREENSBORO NC
27401-2714
US

IV. Provider business mailing address

418 EUGENE CT
GREENSBORO NC
27401-2714
US

V. Phone/Fax

Practice location:
  • Phone: 336-365-8354
  • Fax: 336-365-2380
Mailing address:
  • Phone: 336-365-8354
  • Fax: 336-365-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA23324
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: