Provider Demographics
NPI:1013361922
Name:BLOOM, ADAM (LCPC, LPC, NCC, MAC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BLOOM
Suffix:
Gender:M
Credentials:LCPC, LPC, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 CROCKETT LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6658
Mailing Address - Country:US
Mailing Address - Phone:202-713-5101
Mailing Address - Fax:
Practice Address - Street 1:2301 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5813
Practice Address - Country:US
Practice Address - Phone:202-713-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-17
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6982101YM0800X
DCPRC14773101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health