MEDICARE: TIDELAND MENTAL HEALTH CENTER- PLYMOUTH OFFICE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor
3	1041C0700X	Clinical Social Worker
4	106H00000X	Marriage & Family Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427187657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIDELAND MENTAL HEALTH CENTER- PLYMOUTH OFFICE

Provider Business Mailing Address
First Line	:	716 WASHINGTON ST
Second Line	:
City	:	PLYMOUTH
State	:	NC
Zip	:	27962-2222
Country	:	US
Telephone Number	:	252-793-1154
Fax Number	:	252-793-3860

Provider Business Practice Location Address
First Line	:	716 WASHINGTON ST
Second Line	:
City	:	PLYMOUTH
State	:	NC
Zip	:	27962-2222
Country	:	US
Telephone Number	:	252-793-1154
Fax Number	:	252-793-3860

Authorized Official
Title or Position	:	AREA DIRECTOR
Name	:	MRS. BARBARA MOORE
Credential	:
Telephone Number	:	252-946-8061

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	09/11/2025

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Directions to “TIDELAND MENTAL HEALTH CENTER- PLYMOUTH OFFICE ” Practice Location

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