| Tide Life Therapy Llc | |
|
4 27th Ave Apt A Isle Of Palms SC 29451-2402 | |
| (843) 603-1213 | |
| Not Available |
| Full Name | Tide Life Therapy Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4 27th Ave Apt A, Isle Of Palms, South Carolina |
| Authorized Official Name and Position | Michaela Anne Buckhannon (CLINICIAN) |
| Authorized Official Contact | 8436031213 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tide Life Therapy Llc Po Box 117 Isle Of Palms SC 29451-0117 Ph: (843) 603-1213 | Tide Life Therapy Llc 4 27th Ave Apt A Isle Of Palms SC 29451-2402 Ph: (843) 603-1213 |
| NPI Number | 1356088108 |
|---|---|
| Provider Enumeration Date | 05/13/2022 |
| Last Update Date | 05/13/2022 |
| Certification Date | 05/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356088108 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Aspire Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 Palm Blvd, Isle Of Palms, SC 29451 Phone: 843-810-9479 |