| New Tide Psychotherapy | |
|
753 Johnnie Dodds Blvd Ste 100 Mt Pleasant SC 29464-3054 | |
| (540) 538-5790 | |
| Not Available |
| Full Name | New Tide Psychotherapy |
|---|---|
| Speciality | Social Worker |
| Location | 753 Johnnie Dodds Blvd Ste 100, Mt Pleasant, South Carolina |
| Authorized Official Name and Position | Ashlyn Bradley (OWNER) |
| Authorized Official Contact | 5405385790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Tide Psychotherapy 1425 Long Grove Dr Unit 304 Mt Pleasant SC 29464-8422 Ph: (540) 538-5790 | New Tide Psychotherapy 753 Johnnie Dodds Blvd Ste 100 Mt Pleasant SC 29464-3054 Ph: (540) 538-5790 |
| NPI Number | 1659986685 |
|---|---|
| Provider Enumeration Date | 09/15/2020 |
| Last Update Date | 09/15/2020 |
| Certification Date | 09/15/2020 |
| Medicare PECOS PAC ID | 3274952932 |
|---|---|
| Medicare Enrollment ID | O20200929002453 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659986685 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ashlyn Bradley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619586948 PECOS PAC ID: 8527487289 Enrollment ID: I20200929002582 |
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