Provider Demographics
NPI:1083859318
Name:COASTAL NEUROPSYCHIATRY, PA
Entity Type:Organization
Organization Name:COASTAL NEUROPSYCHIATRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ARCHIE
Authorized Official - Last Name:VAN HORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-347-0356
Mailing Address - Street 1:132 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9260
Mailing Address - Country:US
Mailing Address - Phone:843-347-0356
Mailing Address - Fax:843-347-0390
Practice Address - Street 1:132 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9260
Practice Address - Country:US
Practice Address - Phone:843-347-0356
Practice Address - Fax:843-347-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0TP-0100261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health