Healthcare Provider Details

I. General information

NPI: 1558962688
Provider Name (Legal Business Name): SPRING TIDE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 INDEPENDENCE BLVD STE 100
WILMINGTON NC
28412-0019
US

IV. Provider business mailing address

126 SIXTH AVE S
KURE BEACH NC
28449-3823
US

V. Phone/Fax

Practice location:
  • Phone: 910-333-6134
  • Fax:
Mailing address:
  • Phone: 910-834-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAUREN ELIZABETH SERPE
Title or Position: THERAPIST, OWNER
Credential: MA, LCMHC, LCAS
Phone: 910-834-7008