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General NPI Number Information
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NPI Number | 1609518869
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Entity Type | Organization
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Legal Business Name | CHANGING TIDES THERAPEUTIC & CONSULTATIVE SERVICES, LLC
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Dates
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Enumeration Date | 04/08/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 136 W MAIN ST
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City | ELKTON
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State | MD
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Zip | 21921-5541
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Country | US
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Telephone | 443-350-5565
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2018
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City | ELKTON
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State | MD
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Zip | 21922-2018
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Country | US
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Telephone | 410-996-4878
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | LETHA MOSZER
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Credential | LCSW
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Telephone | 410-996-4878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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