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NPI Code Detail

MEDICARE: NEUROBLOOM BEHAVIORAL HEALTH, LLC

MEDICARE: NEUROBLOOM BEHAVIORAL HEALTH, LLC
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
1101Y00000XCounselor
2101YA0400XAddiction (Substance Use Disorder) Counselor
3101YM0800XMental Health Counselor
4103G00000XClinical Neuropsychologist
5103K00000XBehavior Analyst

General Provider Information

NPI Number : 1942164843
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUROBLOOM BEHAVIORAL HEALTH, LLC
Provider Business Mailing Address
First Line : 1516 BERRIEDALE DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-5503
Country : US
Telephone Number : 910-545-7561
Fax Number :
Provider Business Practice Location Address
First Line : 1516 BERRIEDALE DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-5503
Country : US
Telephone Number : 910-545-7561
Fax Number :
Authorized Official
Title or Position : RBT
Name : DANIELLE STAR HOLZWORTH
Credential :
Telephone Number : 910-545-7561
Provider Enumeration Date : 12/15/2025
Last Update Date : 12/16/2025

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