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Organization
TIDE LIFE THERAPY LLC
Active
Organization
TIDE LIFE THERAPY LLC
Active
Other names
Tide Life Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAELA ANNE BUCKHANNON LISW-CP (CLINICIAN)
(843) 603-1213
Entity
Organization
Contact information
Practice address
4 27TH AVE APT A, ISLE OF PALMS, SC 29451-2402
(843) 603-1213
Mailing address
PO BOX 117, ISLE OF PALMS, SC 29451-0117
(843) 603-1213
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/13/2022
Last updated
05/13/2022
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