Provider Demographics
NPI:1841656147
Name:TIDELINE COUNSELING AND MENTAL HEALTH ASSOCAITES
Entity type:Organization
Organization Name:TIDELINE COUNSELING AND MENTAL HEALTH ASSOCAITES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-276-3487
Mailing Address - Street 1:100 MARINERS DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6666
Mailing Address - Country:US
Mailing Address - Phone:912-276-3487
Mailing Address - Fax:
Practice Address - Street 1:100 MARINERS DR
Practice Address - Street 2:SUITE D
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6666
Practice Address - Country:US
Practice Address - Phone:912-276-3487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty