Healthcare Provider Details

I. General information

NPI: 1205746245
Provider Name (Legal Business Name): BLOOM A NEW DAY MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S WASHINGTON ST STE A
SHELBY NC
28150-4884
US

IV. Provider business mailing address

211 S WASHINGTON ST STE A
SHELBY NC
28150-4884
US

V. Phone/Fax

Practice location:
  • Phone: 704-997-3366
  • Fax: 704-828-7416
Mailing address:
  • Phone: 704-997-3366
  • Fax: 704-828-7416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MORGAN MORGAN
Title or Position: ORGANIZING MEMBER
Credential: PA-C
Phone: 704-997-3366