Tide Pool Counseling PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

TIDE POOL COUNSELING PLLC

Practice address

5561 McNeely Dr Ste 101
Raleigh, NC 27612-7625

Phone

(984) 305-3141

NPI assigned

Dec 7, 2023

Last updated

Jan 30, 2024By 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

Madeline Paige Bonner, MSW, LCSWNPI 1407424542

Title

Owner

Phone

(919) 667-8789

Specialties & licenses 1

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.

• Madeline Paige Bonner, MSW, LCSW

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1407424542
  NPD Authorized official

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

{
    "created_epoch": "1701907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706572800000",
    "number": "1578330791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5561 MCNEELY DR STE 101",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276127625",
            "telephone_number": "984-305-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5561 MCNEELY DR STE 101",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276127625",
            "telephone_number": "984-305-3141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDE POOL COUNSELING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-07",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A",
        "authorized_official_last_name": "BONNER",
        "authorized_official_first_name": "MADELINE",
        "authorized_official_middle_name": "PAIGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-667-8789",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Labreia Keoceansha Thurman, MSW, LCSW-A, LCAS-A
• Rita D Thurman, M.S.
• Theresa Thurman
• Beverly Ann Thurmond, DDS
• Stephen R Tibbels, MD
• Tides of Change Therapy Services PLLC
• Sara Tiegreen, PH.D.
• Kelsie Tieman Overbey, LCSWA
• Julie Trainer Tiffany, M.D.
• Joseph Tigue, PA

• Clinical Social Worker in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; 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.