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General NPI Number Information
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NPI Number | 1336096510
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Entity Type | Organization
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Legal Business Name | MADE TO BLOOM COUNSELING, PLLC
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Dates
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Enumeration Date | 03/16/2026
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 5692 SILER ST
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City | TRINITY
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State | NC
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Zip | 27370-8989
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Country | US
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Telephone | 585-683-0441
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Fax |
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Provider Business Mailing Address
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Address Line | 5692 SILER ST
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City | TRINITY
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State | NC
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Zip | 27370-8989
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Country | US
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Telephone | 585-683-0441
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Fax |
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Authorized Official
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Title or Position | OWNER, MENTAL HEALTH THERAPIST
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Name | JESSICA NOWADLY
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Credential | MSW, LCSW
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Telephone | 585-683-0441
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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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