NPIMap

Organization Active NPI

Tides Counseling and Wellness, PLLC

  • Clinical Social Worker
  • High Point, NC
National Provider Identifier
1790357622
Registry record updated Oct 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
TIDES COUNSELING AND WELLNESS, PLLC
Practice address
2121 Eastchester Dr Ste 105
High Point, NC 27265-1535
Phone
(336) 332-2277
NPI assigned
Jul 12, 2021
Last updated
Oct 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2021

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

Authorized official

Name
Mr. Charles Edward Hubert Jr., MSW, LCSWNPI 1821511759
Title
LCSW
Phone
(336) 332-2277

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

2121 Eastchester Dr Ste 105
High Point, NC 27265-1535

Mailing address

2121 Eastchester Dr Ste 105
High Point, NC 27265-1535
Phone (336) 332-2277

Other practice location 1

159 Sailway Rd
Winston Salem, NC 27127-8906
Phone (336) 281-5005

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Tidescounseling-wellness.net Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211123002419 NC Part B Supplier - Clinic/Group Practice 5799175295 Receives reassigned benefits from 1 practitioner
Practice locations: High Point, NC

National Provider Directory

National Provider Directory

Locations

2121 Eastchester Dr
Ste 105
High Point, NC 27265
Phone (336) 322-2277

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633910400000",
    "number": "1790357622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 EASTCHESTER DR STE 105",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272651535",
            "telephone_number": "336-332-2277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 EASTCHESTER DR STE 105",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272651535",
            "telephone_number": "336-332-2277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "159 Sailway Rd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271278906",
            "country_code": "US",
            "telephone_number": "336-281-5005",
            "fax_number": "336-276-0017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIDES COUNSELING AND WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A",
        "authorized_official_last_name": "HUBERT",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "LCSW",
        "authorized_official_telephone_number": "336-332-2277",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Tidescounseling-wellness.net",
            "affiliation": "N",
            "endpointDescription": "Tides Counseling and Wellness, PLLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2121 Eastchester Dr Ste 105",
            "city": "High Point",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272651535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in High Point, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; 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.