Provider Demographics
NPI:1508603465
Name:LOW TIDE PLAY THERAPY & FAMILY WELLNESS PLLC
Entity type:Organization
Organization Name:LOW TIDE PLAY THERAPY & FAMILY WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAYDEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:AHLBRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCMHCA, NCC
Authorized Official - Phone:970-631-7848
Mailing Address - Street 1:7447 CHIPLEY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-6213
Mailing Address - Country:US
Mailing Address - Phone:970-631-7848
Mailing Address - Fax:
Practice Address - Street 1:107 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3940
Practice Address - Country:US
Practice Address - Phone:910-537-6257
Practice Address - Fax:910-360-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health