Healthcare Provider Details

I. General information

NPI: 1073322368
Provider Name (Legal Business Name): BLOOM COUNSELING OF SANFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 CARBONTON RD STE 220
SANFORD NC
27330-4000
US

IV. Provider business mailing address

628 REGIMENTAL DR
CAMERON NC
28326-7668
US

V. Phone/Fax

Practice location:
  • Phone: 910-225-4665
  • Fax: 910-226-2971
Mailing address:
  • Phone: 910-225-4665
  • Fax: 910-446-2971

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: KIMBERLY DENISE CASEY
Title or Position: OWNER/THERAPIST
Credential: LCMHCS
Phone: 731-592-3351