Provider Demographics
NPI:1417722463
Name:SALT AND TIDES COUNSELING, LLC
Entity Type:Organization
Organization Name:SALT AND TIDES COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EZRIN
Authorized Official - Suffix:
Authorized Official - Credentials:LRC, CRC
Authorized Official - Phone:781-733-5685
Mailing Address - Street 1:16 BROWN BEAR CIR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7115
Mailing Address - Country:US
Mailing Address - Phone:781-733-5685
Mailing Address - Fax:
Practice Address - Street 1:16 BROWN BEAR CIR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7115
Practice Address - Country:US
Practice Address - Phone:781-733-5685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty