Provider Demographics
NPI:1366813925
Name:BLOOMSBURY THERAPY
Entity type:Organization
Organization Name:BLOOMSBURY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:JENKINS
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPCA
Authorized Official - Phone:919-916-5554
Mailing Address - Street 1:16 N BOYLAN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1446
Mailing Address - Country:US
Mailing Address - Phone:919-916-5554
Mailing Address - Fax:
Practice Address - Street 1:16 N BOYLAN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1446
Practice Address - Country:US
Practice Address - Phone:919-916-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty