Tidal Integrated Health, Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

TIDAL INTEGRATED HEALTH, INC

Practice address

1025 Director CT Ste E
Greenville, NC 27858-5996

Phone

(252) 493-6525

NPI assigned

Jun 1, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Kayzandra Leigh Exum Bond, PHDNPI 1366827321

Title

Licensed Psychologist

Phone

(252) 493-6788

Specialties & licenses 8

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kayzandra Leigh Exum Bond, PH.D.

  • Psychologist
  • Goldsboro, NC
  • NPI 1366827321
  NPD Authorized official
• Ryan T Ford

  • Psychologist
  • Goldsboro, NC
  • NPI 1700330651
  NPD (past)
• Sarah Wray Helms, PH.D.

  • Psychologist
  • Greenville, NC
  • NPI 1811270358
  NPD (past)
• Rachel Lynn Kininger, PHD

  • Psychologist
  • Goldsboro, NC
  • NPI 1689163453
  NPD (past)

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

{
    "created_epoch": "1685577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686700800000",
    "number": "1346933561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 NORWOOD AVE STE A",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275341601",
            "telephone_number": "252-493-6788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 DIRECTOR CT STE E",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278585996",
            "telephone_number": "252-493-6525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDAL INTEGRATED HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-01",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A",
        "authorized_official_last_name": "BOND",
        "authorized_official_first_name": "KAYZANDRA",
        "authorized_official_middle_name": "LEIGH EXUM",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "252-493-6788",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debbie Anne Thurneck, PSY.D.
• Tia J Joyner, LLC
• Darla Tiben-Rivera
• Cherrice Applewhite Tice, FNP-C
• Diana Ercilia Ticlavilca-Acuna, DDS
• Tiffany White Parker, DDS, P.a.
• Katherine Marie Tigani, DDS
• Kelly Ann Tiller, PA-C
• Courtney Bean Tilley, CRNA
• Edward Carl Tillley, C.O.

• Clinic/Center in Greenville, NC
• Providers in Greenville, NC by specialty
• Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.