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NPI Code Detail

MEDICARE: TIDELAND MENTAL HEALTH CENTER

MEDICARE: TIDELAND MENTAL HEALTH CENTER
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
1101Y00000XCounselor
2101YP2500XProfessional Counselor
31041C0700XClinical Social Worker
4106H00000XMarriage & Family Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801806500
Entity Type Code : Organization
Provider Name (Legal Business Name) : TIDELAND MENTAL HEALTH CENTER
Provider Business Mailing Address
First Line : 1308 HIGHLAND DR
Second Line :
City : WASHINGTON
State : NC
Zip : 27889-3424
Country : US
Telephone Number : 252-946-8061
Fax Number : 252-946-8078
Provider Business Practice Location Address
First Line : 1308 HIGHLAND DR
Second Line :
City : WASHINGTON
State : NC
Zip : 27889-3424
Country : US
Telephone Number : 252-946-8061
Fax Number : 252-946-8078
Authorized Official
Title or Position : AREA DIRECTOR
Name : MS. BARBARA R MOORE
Credential :
Telephone Number : 252-946-8061
Provider Enumeration Date : 08/08/2006
Last Update Date : 09/11/2025

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Directions to “TIDELAND MENTAL HEALTH CENTER ” Practice Location

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