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General NPI Number Information
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NPI Number | 1366813925
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Entity Type | Organization
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Legal Business Name | BLOOMSBURY THERAPY
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 16 N BOYLAN AVE
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City | RALEIGH
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State | NC
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Zip | 27603-1446
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Country | US
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Telephone | 919-916-5554
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Fax |
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Provider Business Mailing Address
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Address Line | 16 N BOYLAN AVE
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City | RALEIGH
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State | NC
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Zip | 27603-1446
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Country | US
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Telephone | 919-916-5554
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | DR. WHITNEY JENKINS CAIN
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Credential | PHD, LPCA
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Telephone | 919-916-5554
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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 | A11796
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License Number State | NC
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