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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