| Life Tide Counseling Pc | |
|
205 Ward Rd Suite 1 Swansboro NC 28584-8259 | |
| (910) 326-8881 | |
| (910) 326-2342 |
| Full Name | Life Tide Counseling Pc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 205 Ward Rd, Swansboro, North Carolina |
| Authorized Official Name and Position | Carol A. Shepard (PRESIDENT) |
| Authorized Official Contact | 9103268881 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Tide Counseling Pc Po Box 1216 Swansboro NC 28584-1216 Ph: (910) 326-8881 | Life Tide Counseling Pc 205 Ward Rd Suite 1 Swansboro NC 28584-8259 Ph: (910) 326-8881 |
| NPI Number | 1316205354 |
|---|---|
| Provider Enumeration Date | 04/27/2012 |
| Last Update Date | 04/27/2012 |
| Medicare PECOS PAC ID | 5698116929 |
|---|---|
| Medicare Enrollment ID | O20240516003517 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316205354 | NPI | - | NPPES |
| 6105190 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 755 (North Carolina) | Primary |
| Provider Name | Carol Anne Shepard |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1427163088 PECOS PAC ID: 6507207834 Enrollment ID: I20240516003579 |
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