Organization · NPI-2

Changing Tides Wellness Center LLC

Clinic/Center, Mental Health (Including Community Mental Health Center) · Marlton, NJ

NPI number1174304190
StatusActive
Last updated in NPPESNov 29, 2023

Details

NPI
1174304190
Entity type
Organization (NPI-2)
Legal business name
Changing Tides Wellness Center LLC
Organization subpart
No
Enumeration date
Oct 6, 2023
Certification date
Nov 29, 2023
Last updated
Nov 29, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes
261QM0850X Clinic/Center, Adult Mental Health––
261QM2500X Clinic/Center, Medical Specialty––

Practice location

1000 Lincoln Dr E Ste 2
Marlton, NJ 08053-1566

Phone 856-508-0977

Mailing address

199 North Woodbury Rd.
Pitman, NJ 08071

Phone 856-508-0977

Authorized official

Nicholas Desimone
Ceo/Owner
8562179182

Is something wrong?

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