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General NPI Number Information
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NPI Number | 1174397293
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Entity Type | Organization
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Legal Business Name | BLOOM COUNSELING COLLABORATIVE PLLC
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 6640 W WILKINSON BLVD STE 350
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City | BELMONT
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State | NC
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Zip | 28012-2796
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Country | US
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Telephone | 980-277-0155
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1161
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City | BELMONT
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State | NC
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Zip | 28012-1161
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | CATHERINE BRUCE
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Credential | LCSW
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Telephone | 704-689-4239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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