Healthcare Provider Details

I. General information

NPI: 1245970664
Provider Name (Legal Business Name): TIDAL COUNSELING, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E PLUME ST STE 327B
NORFOLK VA
23510-1757
US

IV. Provider business mailing address

208 E PLUME ST STE 327B
NORFOLK VA
23510-1757
US

V. Phone/Fax

Practice location:
  • Phone: 757-637-0840
  • Fax:
Mailing address:
  • Phone: 757-637-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: RUTH H BYBEE
Title or Position: PRESIDENT
Credential:
Phone: 757-418-1131