Wild Bloom Wellness

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

WILD BLOOM WELLNESS

Practice address

11220 Treynorth Dr Ste a
Cornelius, NC 28031-8198

Phone

(980) 272-0157

NPI assigned

Nov 20, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Summer Mendez, LCSWNPI 1588322135

Title

Owner/Admin

Phone

(980) 272-0157

Specialties & licenses 1

Addresses

Other names 1

• Wild Bloom Counseling Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Summer Mendez, MSW, LCSW

  • Clinical Social Worker
  • Cornelius, NC
  • NPI 1588322135
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1763596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783641600000",
    "number": "1629939392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11220 TREYNORTH DR STE A",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280318198",
            "telephone_number": "980-272-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11220 TREYNORTH DR STE A",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280318198",
            "telephone_number": "980-272-0157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD BLOOM WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-20",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A",
        "authorized_official_last_name": "MENDEZ",
        "authorized_official_first_name": "SUMMER",
        "authorized_official_title_or_position": "OWNER/ADMIN",
        "authorized_official_telephone_number": "980-272-0157",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wild Bloom Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Zachary Whiteman, LMBT
• Daniela M. Whiteside, MD
• Heather Whiteside
• Doris Fiorillo Wicks, RD, LDN, CNSC
• Erin Wilbanks, DDS
• Wilder Wellness Center
• Ashley Wilkens, FNP-BC
• Autumn Brooks Williams
• Iesha Teresa Lee Williams, LCMHC, LCAS-A,
• James Williams

• Clinical Social Worker in Cornelius, NC
• Providers in Cornelius, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.