Active NPI
Molly C Bloomer, LCMHCA
- Mental Health Counselor
- Charlotte, NC
National Provider Identifier
1083395446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- A19021
- Practice address
- 4730 Park Rd Ste a
Charlotte, NC 28209-4205 - Phone
- (704) 800-4436
- NPI assigned
- Jul 28, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | A19021 | NC | Primary |
Addresses
Primary practice location
4730 Park Rd Ste a
Charlotte, NC 28209-4205
Mailing address
4824 Water Oak Rd Apt 6
Charlotte, NC 28211-2451
Phone (704) 654-6112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A19021 | NC | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Modern Era Counseling, PLLC | Mental Health | Current | Accepting new patients |
Locations
4730 Park Rd
Ste A
Charlotte, NC 28209
Phone (704) 317-7638
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690502400000",
"number": "1083395446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4824 WATER OAK RD APT 6",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282112451",
"telephone_number": "704-654-6112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4730 PARK RD STE A",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282094205",
"telephone_number": "704-800-4436"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOMER",
"first_name": "MOLLY",
"middle_name": "C",
"credential": "LCMHCA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-28",
"last_updated": "2023-07-28",
"certification_date": "2023-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "A19021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.