Healthcare Provider Details

I. General information

NPI: 1396659371
Provider Name (Legal Business Name): MINDS IN BLOOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 MANNINGTON DR
WILLIAMSTOWN NJ
08094-8817
US

IV. Provider business mailing address

2207 LOFTS DR
PRINCETON NJ
08540-8204
US

V. Phone/Fax

Practice location:
  • Phone: 856-296-8982
  • Fax:
Mailing address:
  • Phone: 856-296-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIET NWACHUKWU
Title or Position: OWNER
Credential:
Phone: 856-296-8982