Provider Demographics
NPI:1144874447
Name:THE CHANGING TIDE BODY, MIND & SPIRIT P.C.
Entity type:Organization
Organization Name:THE CHANGING TIDE BODY, MIND & SPIRIT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:GIULIANA
Authorized Official - Last Name:MOORE-ZIEROW
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-BC, PMHNP-B
Authorized Official - Phone:804-725-3041
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:MATHEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23109-0327
Mailing Address - Country:US
Mailing Address - Phone:804-725-3041
Mailing Address - Fax:804-725-3041
Practice Address - Street 1:10978 BUCKLEY HALL ROAD
Practice Address - Street 2:
Practice Address - City:MATHEWS
Practice Address - State:VA
Practice Address - Zip Code:23109-2310
Practice Address - Country:US
Practice Address - Phone:804-725-3041
Practice Address - Fax:804-725-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty