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General NPI Number Information
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NPI Number | 1811273568
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Entity Type | Organization
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Legal Business Name | TIDES OF CHANGE
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 333 W WILCOX DR STE. 303
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-1789
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Country | US
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Telephone | 520-458-2250
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Fax | 520-458-2269
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Provider Business Mailing Address
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Address Line | 333 W WILCOX DR STE. 303
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-1789
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Country | US
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Telephone | 520-458-2250
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Fax | 520-458-2269
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Authorized Official
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Title or Position | CEO/PARTNER
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Name | MRS. MARIANNE S VALLADARES
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Credential | LCSW
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Telephone | 520-458-2250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC12687
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC10504
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LMSW
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW12394
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW2922
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW2811
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License Number State | AZ
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Taxonomy #7
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW10948
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License Number State | AZ
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