Provider Demographics
NPI:1790357622
Name:TIDES COUNSELING AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:TIDES COUNSELING AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HUBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:336-332-2277
Mailing Address - Street 1:2121 EASTCHESTER DR STE 105
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1535
Mailing Address - Country:US
Mailing Address - Phone:336-332-2277
Mailing Address - Fax:
Practice Address - Street 1:2121 EASTCHESTER DR STE 105
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1535
Practice Address - Country:US
Practice Address - Phone:336-332-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty