Provider Demographics
NPI:1245846971
Name:HEALING TIDE THERAPY LLC
Entity type:Organization
Organization Name:HEALING TIDE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:EMILY
Authorized Official - Last Name:WORCESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW-CC, LADC, CCS
Authorized Official - Phone:207-615-2022
Mailing Address - Street 1:29 ELIOT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5919
Mailing Address - Country:US
Mailing Address - Phone:207-615-2022
Mailing Address - Fax:
Practice Address - Street 1:29 ELIOT ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5919
Practice Address - Country:US
Practice Address - Phone:207-615-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty