Provider Demographics
NPI:1306546320
Name:TIDES OF CHANGE THERAPEUTIC SERVICES, LLC
Entity type:Organization
Organization Name:TIDES OF CHANGE THERAPEUTIC SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERSENDE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHLEICHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-309-2351
Mailing Address - Street 1:PO BOX 139
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-0139
Mailing Address - Country:US
Mailing Address - Phone:240-309-2351
Mailing Address - Fax:240-526-2347
Practice Address - Street 1:41660 COURTHOUSE DR
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3887
Practice Address - Country:US
Practice Address - Phone:240-309-2351
Practice Address - Fax:240-526-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty