| Changing Tides Therapeutic & Consultative Services, Llc | |
|
136 W Main St Elkton MD 21921-5541 | |
| (443) 350-5565 | |
| Not Available |
| Full Name | Changing Tides Therapeutic & Consultative Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 136 W Main St, Elkton, Maryland |
| Authorized Official Name and Position | Letha Moszer (PROVIDER) |
| Authorized Official Contact | 4109964878 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Changing Tides Therapeutic & Consultative Services, Llc Po Box 2018 Elkton MD 21922-2018 Ph: (410) 996-4878 | Changing Tides Therapeutic & Consultative Services, Llc 136 W Main St Elkton MD 21921-5541 Ph: (443) 350-5565 |
| NPI Number | 1609518869 |
|---|---|
| Provider Enumeration Date | 04/08/2022 |
| Last Update Date | 08/05/2022 |
| Certification Date | 08/05/2022 |
| Medicare PECOS PAC ID | 3173904604 |
|---|---|
| Medicare Enrollment ID | O20220714004198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609518869 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Carrie Bailey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013681956 PECOS PAC ID: 1254712789 Enrollment ID: I20220714004244 |
| Provider Name | Ashley Mattix |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386226587 PECOS PAC ID: 5698159697 Enrollment ID: I20220824003724 |
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