Provider Demographics
NPI:1093032310
Name:COASTAL SOUTHEASTERN UNITED CARE LLC
Entity Type:Organization
Organization Name:COASTAL SOUTHEASTERN UNITED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-755-5222
Mailing Address - Street 1:PO BOX 1585
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28459-1585
Mailing Address - Country:US
Mailing Address - Phone:910-796-3350
Mailing Address - Fax:910-796-3353
Practice Address - Street 1:818 S MAIN ST
Practice Address - Street 2:SUITE 100-104
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320
Practice Address - Country:US
Practice Address - Phone:910-863-4000
Practice Address - Fax:910-863-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health