New Tide Psychotherapy

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

NEW TIDE PSYCHOTHERAPY

Practice address

753 Johnnie Dodds Blvd Ste 100
Mt Pleasant, SC 29464-3054

Phone

(540) 538-5790

NPI assigned

Sep 15, 2020

Last updated

Sep 15, 2020By 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

Ashlyn Bradley, LISW-CPNPI 1619586948

Title

Owner

Phone

(540) 538-5790

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

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.

• Ashlyn Bradley, LISW-CP

  • Clinical Social Worker
  • Mount Pleasant, SC
  • NPI 1619586948
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600128000000",
    "number": "1659986685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 LONG GROVE DR UNIT 304",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294648422",
            "telephone_number": "540-538-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "753 JOHNNIE DODDS BLVD STE 100",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294643054",
            "telephone_number": "540-538-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW TIDE PSYCHOTHERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-15",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "ASHLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-538-5790",
        "authorized_official_credential": "LISW-CP"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Clinical Social Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; 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.