Organization
TIDELINE PSYCH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM THOMAS BUNTING JR. (PRACTICE MANAGER)
(252) 341-3320
Entity
Organization
Contact information
Practice address
226 N FRONT ST # 129, WILMINGTON, NC 28401-3920
(910) 469-4690
(910) 933-7084
Mailing address
226 N FRONT ST # 129, WILMINGTON, NC 28401-3920
(910) 469-4690
(910) 933-7084
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/23/2024
Last updated
10/23/2024
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