| Changing Tides Counseling & Behavioral Health, Llc | |
|
137 National Plz Ste 300 Oxon Hill MD 20745-1153 | |
| (240) 273-3117 | |
| Not Available |
| Full Name | Changing Tides Counseling & Behavioral Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 137 National Plz Ste 300, Oxon Hill, Maryland |
| Authorized Official Name and Position | Kelly Jackson (CEO) |
| Authorized Official Contact | 3013959033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Changing Tides Counseling & Behavioral Health, Llc 137 National Plz Ste 300 Oxon Hill MD 20745-1153 Ph: (301) 327-1073 | Changing Tides Counseling & Behavioral Health, Llc 137 National Plz Ste 300 Oxon Hill MD 20745-1153 Ph: (240) 273-3117 |
| NPI Number | 1841859931 |
|---|---|
| Provider Enumeration Date | 06/11/2019 |
| Last Update Date | 04/10/2024 |
| Certification Date | 04/10/2024 |
| Medicare PECOS PAC ID | 3971838541 |
|---|---|
| Medicare Enrollment ID | O20190718002504 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841859931 | NPI | - | NPPES |
| Provider Name | Kelly Wells |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710435953 PECOS PAC ID: 3476892068 Enrollment ID: I20190226001346 |
| Provider Name | Larissa Dinatale |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558012807 PECOS PAC ID: 5092189068 Enrollment ID: I20230315001608 |
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