Healthcare Provider Details

I. General information

NPI: 1801806500
Provider Name (Legal Business Name): TIDELAND MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 HIGHLAND DR
WASHINGTON NC
27889-3424
US

IV. Provider business mailing address

1308 HIGHLAND DR
WASHINGTON NC
27889-3424
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-8061
  • Fax: 252-946-8078
Mailing address:
  • Phone: 252-946-8061
  • Fax: 252-946-8078

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: MS. BARBARA R MOORE
Title or Position: AREA DIRECTOR
Credential:
Phone: 252-946-8061