MEDICARE: TIDE TOGETHER WELLNESS & SUPPORT LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1619850344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIDE TOGETHER WELLNESS & SUPPORT LLC

Provider Business Mailing Address
First Line	:	168 CAROL PL
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-7312
Country	:	US
Telephone Number	:	704-661-3327
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 CONSTITUTION DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3456
Country	:	US
Telephone Number	:	704-661-3327
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SABRINA BETTS
Credential	:
Telephone Number	:	704-661-3327

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	07/29/2025

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