Healthcare Provider Details

I. General information

NPI: 1952285645
Provider Name (Legal Business Name): TIDES OF CHANGE BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 6TH AVE STE 103
YORK PA
17403-2626
US

IV. Provider business mailing address

3703 SKIPTON CIR
YORK PA
17402-4420
US

V. Phone/Fax

Practice location:
  • Phone: 717-973-6786
  • Fax: 717-483-2088
Mailing address:
  • Phone: 717-873-6207
  • Fax: 717-467-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE HEIST
Title or Position: PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 717-873-6207