Organization
CHANGING TIDES WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS DESIMONE LPC, LCADC (CEO/OWNER)
(856) 217-9182
Entity
Organization
Contact information
Practice address
1000 LINCOLN DR E STE 2, MARLTON, NJ 08053-1566
(856) 508-0977
Mailing address
199 NORTH WOODBURY RD., PITMAN, NJ 08071
(856) 508-0977
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Enumeration date
10/06/2023
Last updated
11/29/2023
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