Provider Demographics
NPI:1326324765
Name:TIDEWATER COUNSELING, PLLC
Entity Type:Organization
Organization Name:TIDEWATER COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, RPT, CTS
Authorized Official - Phone:252-229-9053
Mailing Address - Street 1:5126 CHALK ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2559
Mailing Address - Country:US
Mailing Address - Phone:252-229-9053
Mailing Address - Fax:252-648-8381
Practice Address - Street 1:1401 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-5502
Practice Address - Country:US
Practice Address - Phone:252-229-9053
Practice Address - Fax:252-648-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty