Provider Demographics
NPI:1588355218
Name:BLOOM IN JOURNEY PLLC
Entity type:Organization
Organization Name:BLOOM IN JOURNEY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMBIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:862-290-0353
Mailing Address - Street 1:2929 DELAWARE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3703
Mailing Address - Country:US
Mailing Address - Phone:862-290-0353
Mailing Address - Fax:
Practice Address - Street 1:2929 DELAWARE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3703
Practice Address - Country:US
Practice Address - Phone:862-290-0353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty