Life Tide Counseling PC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

755 Issued in NC

Legal business name

LIFE TIDE COUNSELING PC

Practice address

205 Ward Rd
Suite 1
Swansboro, NC 28584-8259

Phone

(910) 326-8881

Fax

(910) 326-2342

NPI assigned

Apr 27, 2012

Last updated

Apr 27, 2012By 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

Mrs. Carol A. Shepard, LMFTNPI 1427163088

Title

President

Phone

(910) 326-8881

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 3

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.

• Carol Anne Shepard, LMFT

  • Marriage & Family Therapist
  • Swansboro, NC
  • NPI 1427163088
  Medicare reassignment NPD Authorized official
• Jessica Sanders Prescott, LCMHC

  • Mental Health Counselor
  • Durham, NC
  • NPI 1275821662
  Medicare reassignment NPD
• Cherie Bedford, LPC

  • Professional Counselor
  • Swansboro, NC
  • NPI 1447533120
  NPD (past)

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335484800000",
    "number": "1316205354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1216",
            "city": "SWANSBORO",
            "state": "NC",
            "postal_code": "285841216",
            "telephone_number": "910-326-8881",
            "fax_number": "910-326-2342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 WARD RD",
            "address_2": "SUITE 1",
            "city": "SWANSBORO",
            "state": "NC",
            "postal_code": "285848259",
            "telephone_number": "910-326-8881",
            "fax_number": "910-326-2342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE TIDE COUNSELING PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-27",
        "last_updated": "2012-04-27",
        "status": "A",
        "authorized_official_last_name": "SHEPARD",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-326-8881",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6105190",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sharna Michelle Jones, LICENSED OPTICIAN
• Cassie Joyner
• Jill H Kidd
• Kenna Marie Kleinert
• Cody Leatherwood
• Katherine Light, MSW, LCSWA
• Lomakatsi, PLLC
• Emily Long
• Matthew Thomas Long, PA-C
• Lorin Technologies Corporation

• Marriage & Family Therapist in Swansboro, NC
• Providers in Swansboro, NC by specialty
• Marriage & Family Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.