# TIDELAND MENTAL HEALTH CENTER- MATT OPP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053441782
- **Authorized official:** MRS. BARBARA MOORE (AREA DIRECTOR)
- **Authorized official phone:** (252) 946-8061

## Contact information

- **Practice address:** 69 CHURCH STREET, FAIRFIELD, NC 27826
- **Practice address phone:** (252) 926-3731
- **Practice address fax:** (252) 926-3213
- **Mailing address:** PO BOX 36, FAIRFIELD, NC 27826-0036
- **Mailing address phone:** (252) 926-3731
- **Mailing address fax:** (252) 926-3213

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/06/2007
- **Last updated:** 09/11/2025