Healthcare Provider Details

I. General information

NPI: 1659400380
Provider Name (Legal Business Name): TIDELAND MENTAL HEALTH CENTER- COLUMBIA OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 HIGHWAY 64 EAST
COLUMBIA NC
27925
US

IV. Provider business mailing address

PO BOX 202
COLUMBIA NC
27925-0202
US

V. Phone/Fax

Practice location:
  • Phone: 252-796-0595
  • Fax: 252-796-0211
Mailing address:
  • Phone: 252-796-0595
  • Fax: 252-796-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA MOORE
Title or Position: AREA DIRECTOR
Credential:
Phone: 252-946-8061