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NPI Code Detail

MEDICARE: TIDES COUNSELING AND WELLNESS, PLLC

MEDICARE: TIDES COUNSELING AND WELLNESS, 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
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1790357622
Entity Type Code : Organization
Provider Name (Legal Business Name) : TIDES COUNSELING AND WELLNESS, PLLC
Provider Business Mailing Address
First Line : 2121 EASTCHESTER DR STE 105
Second Line :
City : HIGH POINT
State : NC
Zip : 27265-1535
Country : US
Telephone Number : 336-332-2277
Fax Number :
Provider Business Practice Location Address
First Line : 2121 EASTCHESTER DR STE 105
Second Line :
City : HIGH POINT
State : NC
Zip : 27265-1535
Country : US
Telephone Number : 336-332-2277
Fax Number :
Authorized Official
Title or Position : LCSW
Name : MR. CHARLES EDWARD HUBERT JR.
Credential : MSW, LCSW
Telephone Number : 336-332-2277
Provider Enumeration Date : 07/12/2021
Last Update Date : 10/11/2021

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