MEDICARE: SPRING TIDE COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1558962688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING TIDE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	126 SIXTH AVE S
Second Line	:
City	:	KURE BEACH
State	:	NC
Zip	:	28449-3823
Country	:	US
Telephone Number	:	910-834-7008
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 INDEPENDENCE BLVD STE 100
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-0019
Country	:	US
Telephone Number	:	910-333-6134
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST, OWNER
Name	:	LAUREN ELIZABETH SERPE
Credential	:	MA, LCMHC, LCAS
Telephone Number	:	910-834-7008

Provider Enumeration Date	:	11/04/2020
Last Update Date	:	07/22/2025

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