Provider Demographics
NPI:1235953308
Name:BLOOM JOY LLC
Entity type:Organization
Organization Name:BLOOM JOY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MIRIAH
Authorized Official - Last Name:EMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA
Authorized Official - Phone:919-576-0383
Mailing Address - Street 1:1909 PINEMIST PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8345
Mailing Address - Country:US
Mailing Address - Phone:919-576-0383
Mailing Address - Fax:
Practice Address - Street 1:1909 PINEMIST PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8345
Practice Address - Country:US
Practice Address - Phone:919-576-0383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty