Changing Tides Counseling & Behavioral Health, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

CHANGING TIDES COUNSELING & BEHAVIORAL HEALTH, LLC

Practice address

137 National PLZ Ste 300
Oxon Hill, MD 20745-1153

Phone

(240) 273-3117

NPI assigned

Jun 11, 2019

Organization subpart

No

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

Authorized official

Name

Kelly Jackson, PHD, LCSWNPI 1710435953

Title

Ceo

Phone

(301) 395-9033

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 2

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

• Kelly Jackson, LCSW-C

  • Clinical Social Worker
  • National Harbor, MD
  • NPI 1710435953

  DC

  Medicare reassignment NPD Authorized official
• Kameke Richardson-Owens

  • Social Worker
  • Oxon Hill, MD
  • NPI 1427704683
  NPD (past)

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1841859931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 NATIONAL PLZ STE 300",
            "city": "OXON HILL",
            "state": "MD",
            "postal_code": "207451153",
            "telephone_number": "301-327-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 NATIONAL PLZ STE 300",
            "city": "OXON HILL",
            "state": "MD",
            "postal_code": "207451153",
            "telephone_number": "240-273-3117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGING TIDES COUNSELING & BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-11",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-395-9033",
        "authorized_official_credential": "PHD, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cinda J Catchings, RD
• Cell Soloutions Plus LLC
• Cell Soloutions Plus LLC
• Center for Interventional Medicine, LLC (VidaVascular)
• Karen Ama-Serwa Chachu, MD
• Arash Ari Changizi, DPM
• Shannon Chapman, DDS
• Javelle Lenise Chase
• Michael Francis Chiaramonte, M.D.
• Shobha I Chidambaram, M.D.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Oxon Hill, MD
• Providers in Oxon Hill, MD by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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.