Provider Demographics
NPI:1558962688
Name:SPRING TIDE COUNSELING PLLC
Entity Type:Organization
Organization Name:SPRING TIDE COUNSELING PLLC
Other - Org Name:WOMEN'S INTEGRATIVE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SERPE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHC, LCAS
Authorized Official - Phone:910-333-6134
Mailing Address - Street 1:126 SIXTH AVE S
Mailing Address - Street 2:
Mailing Address - City:KURE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28449-3823
Mailing Address - Country:US
Mailing Address - Phone:910-333-6134
Mailing Address - Fax:
Practice Address - Street 1:4829 CAROLINA BEACH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2367
Practice Address - Country:US
Practice Address - Phone:910-333-6134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty