Healthcare Provider Details

I. General information

NPI: 1376457531
Provider Name (Legal Business Name): BLOOMING MIND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11010 LAKE GROVE BLVD STE 100-192
MORRISVILLE NC
27560-7391
US

IV. Provider business mailing address

11010 LAKE GROVE BLVD STE 100-192
MORRISVILLE NC
27560-7391
US

V. Phone/Fax

Practice location:
  • Phone: 330-984-3150
  • Fax:
Mailing address:
  • Phone: 330-984-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAILA CARTER
Title or Position: COUNSELOR
Credential: LCMHC
Phone: 330-984-3150