Organization
CHANGING TIDES COUNSELING & BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY JACKSON PHD, LCSW (CEO)
(301) 395-9033
Entity
Organization
Contact information
Practice address
137 NATIONAL PLZ STE 300, OXON HILL, MD 20745-1153
(240) 273-3117
Mailing address
137 NATIONAL PLZ STE 300, OXON HILL, MD 20745-1153
(301) 327-1073
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
06/11/2019
Last updated
04/10/2024
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