Provider Demographics
NPI:1255209920
Name:BLOOM THERAPY AND WELLNESS
Entity type:Organization
Organization Name:BLOOM THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA
Authorized Official - Phone:252-479-0999
Mailing Address - Street 1:5540 CENTERVIEW DR STE 204
Mailing Address - Street 2:#650147
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-8012
Mailing Address - Country:US
Mailing Address - Phone:252-513-4020
Mailing Address - Fax:
Practice Address - Street 1:106 S FOURTH ST
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-2653
Practice Address - Country:US
Practice Address - Phone:252-513-4020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty