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General NPI Number Information
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NPI Number | 1013705318
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Entity Type | Organization
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Legal Business Name | TIDES OF CHANGE BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 1600 6TH AVE STE 103
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City | YORK
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State | PA
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Zip | 17403-2626
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Country | US
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Telephone | 717-873-6207
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Fax | 717-467-4077
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Provider Business Mailing Address
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Address Line | 3703 SKIPTON CIR
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City | YORK
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State | PA
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Zip | 17402-4420
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Country | US
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Telephone |
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Fax | 717-467-4077
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DANIELLE HEIST
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Credential | LPC
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Telephone | 717-873-6207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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