Organization
TIDAL INTEGRATED HEALTH, INC
Active
Organization
TIDAL INTEGRATED HEALTH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAYZANDRA LEIGH EXUM BOND PHD (LICENSED PSYCHOLOGIST)
(252) 493-6788
Entity
Organization
Contact information
Practice address
1025 DIRECTOR CT STE E, GREENVILLE, NC 27858-5996
(252) 493-6525
Mailing address
2307 NORWOOD AVE STE A, GOLDSBORO, NC 27534-1601
(252) 493-6788
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
06/01/2023
Last updated
06/14/2023
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