Provider Demographics
NPI:1124559471
Name:COASTAL INNOVATIVE COUNSELING SOLUTIONS, LLC
Entity Type:Organization
Organization Name:COASTAL INNOVATIVE COUNSELING SOLUTIONS, LLC
Other - Org Name:HELEN SCHANDOLPH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:912-713-6275
Mailing Address - Street 1:PO BOX 13309
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-0309
Mailing Address - Country:US
Mailing Address - Phone:912-495-5600
Mailing Address - Fax:855-223-9969
Practice Address - Street 1:1 JOHNSTON ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5531
Practice Address - Country:US
Practice Address - Phone:912-495-5600
Practice Address - Fax:855-223-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0030681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD465197000OtherMAGELLAN BEHAVIORAL HEALTH
GACSW003068OtherCLINICAL SOCIAL WORKER
GA80BBFTGMedicare UPIN