Provider Demographics
NPI:1134308349
Name:COASTAL FAMILY SERVICES, PLLC
Entity Type:Organization
Organization Name:COASTAL FAMILY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ANTOINE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:910-891-1222
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28335-0068
Mailing Address - Country:US
Mailing Address - Phone:910-891-1222
Mailing Address - Fax:910-891-1333
Practice Address - Street 1:1100 S CLINTON AVE STE C
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-6325
Practice Address - Country:US
Practice Address - Phone:910-891-1222
Practice Address - Fax:910-891-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006431Medicaid