MEDICARE: NEUROBLOOM COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1710844048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROBLOOM COUNSELING PLLC

Provider Business Mailing Address
First Line	:	12305 KENDALL RIDGE CT
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-8541
Country	:	US
Telephone Number	:	919-537-9763
Fax Number	:

Provider Business Practice Location Address
First Line	:	12305 KENDALL RIDGE CT
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-8541
Country	:	US
Telephone Number	:	919-537-9763
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	STEPHENS CHERRY
Credential	:	MS, CRC, LCMHC
Telephone Number	:	910-619-9757

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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