Changing Tides Wellness Center LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

CHANGING TIDES WELLNESS CENTER LLC

Practice address

1000 Lincoln Dr E Ste 2
Marlton, NJ 08053-1566

Phone

(856) 508-0977

NPI assigned

Oct 6, 2023

Last updated

Nov 29, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicholas Desimone, LPC, LCADCNPI 1346788676

Title

Ceo/Owner

Phone

(856) 217-9182

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicholas Desimone

  • Professional Counselor
  • Laurel Springs, NJ
  • NPI 1346788676
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701216000000",
    "number": "1174304190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 NORTH WOODBURY RD.",
            "city": "PITMAN",
            "state": "NJ",
            "postal_code": "08071",
            "telephone_number": "856-508-0977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 LINCOLN DR E STE 2",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080531566",
            "telephone_number": "856-508-0977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGING TIDES WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-06",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A",
        "authorized_official_last_name": "DESIMONE",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "856-217-9182",
        "authorized_official_credential": "LPC, LCADC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juliana Vocca Chakrabarti, MS, RD, CSP, LDN
• Brittany Chalfant, APN
• Sandra Chalik, MS OTR/L
• Alice Chang, M.D.
• Andy Chang
• Ramu Channamsetty, MD
• Rudolph Chao, DMD
• Charles M. Cummins, OD, PA
• Charles P Procini DDS PA
• Barbara Lotte Chase, LCSW

• Mental Health Clinic/Center (Including Community Mental Health Center) in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.