Healthcare Provider Details

I. General information

NPI: 1891625067
Provider Name (Legal Business Name): ELEVEN IN BLOOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 LONG PIER LANE
RALEIGH NC
27610
US

IV. Provider business mailing address

3064 WAKE FOREST RD # 1368
RALEIGH NC
27609-7844
US

V. Phone/Fax

Practice location:
  • Phone: 919-864-5817
  • Fax:
Mailing address:
  • Phone: 919-864-5817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ZENA CHASE
Title or Position: CEO/DIRECTOR
Credential: LCMHC, QS, LCASA
Phone: 919-864-5817