Healthcare Provider Details

I. General information

NPI: 1336096510
Provider Name (Legal Business Name): MADE TO BLOOM COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5692 SILER ST
TRINITY NC
27370-8989
US

IV. Provider business mailing address

5692 SILER ST
TRINITY NC
27370-8989
US

V. Phone/Fax

Practice location:
  • Phone: 585-683-0441
  • Fax:
Mailing address:
  • Phone: 585-683-0441
  • Fax:

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: JESSICA NOWADLY
Title or Position: OWNER, MENTAL HEALTH THERAPIST
Credential: MSW, LCSW
Phone: 585-683-0441