Healthcare Provider Details

I. General information

NPI: 1225822034
Provider Name (Legal Business Name): TIDES OF CHANGE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 LAKE PARK BLVD N STE 109
CAROLINA BEACH NC
28428-3906
US

IV. Provider business mailing address

1208 BURNETT RD
WILMINGTON NC
28409-4900
US

V. Phone/Fax

Practice location:
  • Phone: 910-622-8388
  • Fax: 910-798-2811
Mailing address:
  • Phone: 919-770-3727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY B GREER
Title or Position: OWNER/ PSYCHOTHERAPIST
Credential: MS, LCMHC
Phone: 910-622-8388