# THE CHANGING TIDE BODY, MIND & SPIRIT P.C.

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

## Provider details

- **NPI number:** 1144874447
- **Authorized official:** DEBRA GIULIANA MOORE-ZIEROW MSN, FNP-BC, PMHNP-B (CEO)
- **Authorized official phone:** (804) 725-3041

## Contact information

- **Practice address:** 10978 BUCKLEY HALL ROAD, MATHEWS, VA 23109-2310
- **Practice address phone:** (804) 725-3041
- **Practice address fax:** (804) 725-3510
- **Mailing address:** PO BOX 327, MATHEWS, VA 23109-0327
- **Mailing address phone:** (804) 725-3041
- **Mailing address fax:** (804) 725-3041

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/25/2019
- **Last updated:** 06/12/2023