Organization
TIDES OF CHANGE
Active
Organization
TIDES OF CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIANNE S VALLADARES LCSW (CEO/PARTNER)
(520) 458-2250
Entity
Organization
Contact information
Practice address
333 W WILCOX DR, STE. 303, SIERRA VISTA, AZ 85635-1789
(520) 458-2250
(520) 458-2269
Mailing address
333 W WILCOX DR, STE. 303, SIERRA VISTA, AZ 85635-1789
(520) 458-2250
(520) 458-2269
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC12687
AZ
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC10504
AZ
1041C0700X
Clinical Social Worker
Primary
LCSW10948
AZ
1041C0700X
Clinical Social Worker
LCSW12394
AZ
1041C0700X
Clinical Social Worker
LCSW2811
AZ
1041C0700X
Clinical Social Worker
LCSW2922
—
1041C0700X
Clinical Social Worker
LMSW
AZ
Other
Enumeration date
10/26/2011
Last updated
10/26/2011
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