MEDICARE: TIDES OF CHANGE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1225822034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIDES OF CHANGE PLLC

Provider Business Mailing Address
First Line	:	1208 BURNETT RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-4900
Country	:	US
Telephone Number	:	919-770-3727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 LAKE PARK BLVD N STE 109
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-3906
Country	:	US
Telephone Number	:	910-622-8388
Fax Number	:	910-798-2811

Authorized Official
Title or Position	:	OWNER/ PSYCHOTHERAPIST
Name	:	BRITTANY B GREER
Credential	:	MS, LCMHC
Telephone Number	:	910-622-8388

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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