Provider Demographics
NPI:1619850344
Name:TIDE TOGETHER WELLNESS & SUPPORT LLC
Entity type:Organization
Organization Name:TIDE TOGETHER WELLNESS & SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-661-3327
Mailing Address - Street 1:168 CAROL PL
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-7312
Mailing Address - Country:US
Mailing Address - Phone:704-661-3327
Mailing Address - Fax:
Practice Address - Street 1:2 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3456
Practice Address - Country:US
Practice Address - Phone:704-661-3327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health