# BLOOM CONNECT & WELLNESS CENTER PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578416137
- **Authorized official:** KENNETH MBUEN PMHNP-BC (CEO/FOUNDER)
- **Authorized official phone:** (336) 740-6347

## Contact information

- **Practice address:** 10562 TATTERSALL DR, MANASSAS, VA 20112-2407
- **Practice address phone:** (571) 518-8036
- **Practice address fax:** (540) 208-1679
- **Mailing address:** 4102 PARAPET CT, FREDERICKSBURG, VA 22408-2564
- **Mailing address phone:** (571) 518-8036
- **Mailing address fax:** (540) 208-1679

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | — | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/16/2026
- **Last updated:** 03/07/2026