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Organization

LIFE TIDE COUNSELING PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. CAROL A. SHEPARD LMFT (PRESIDENT)
(910) 326-8881
Entity
Organization

Contact information

Practice address
205 WARD RD, SUITE 1, SWANSBORO, NC 28584-8259
(910) 326-8881
(910) 326-2342
Mailing address
PO BOX 1216, SWANSBORO, NC 28584-1216
(910) 326-8881
(910) 326-2342

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
755
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6105190
NC
Enumeration date
04/27/2012
Last updated
04/27/2012
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