Healthcare Provider Details

I. General information

NPI: 1316609787
Provider Name (Legal Business Name): TIDES CENTER FOR WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N CAUSEWAY BLVD
METAIRIE LA
70001-5364
US

IV. Provider business mailing address

804 N CAUSEWAY BLVD
METAIRIE LA
70001-5364
US

V. Phone/Fax

Practice location:
  • Phone: 504-330-4560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE PATTESON POEHLING
Title or Position: OWNER
Credential: LCSW
Phone: 504-330-4560