Healthcare Provider Details

I. General information

NPI: 1750290094
Provider Name (Legal Business Name): JUNIPER BLOOM THERAPY COLLECTIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 S EAST ST
RALEIGH NC
27601-2369
US

IV. Provider business mailing address

219 S EAST ST
RALEIGH NC
27601-2369
US

V. Phone/Fax

Practice location:
  • Phone: 984-258-8568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: TAMEDRA BIERNACKI
Title or Position: OWNER/MEMBER
Credential: LMFT
Phone: 984-258-8568