Provider Demographics
NPI:1154051415
Name:COASTAL CONNECTIONS THERAPY AND COUNSELING SERVICES INC.
Entity Type:Organization
Organization Name:COASTAL CONNECTIONS THERAPY AND COUNSELING SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-209-0897
Mailing Address - Street 1:2905 CAMINITO NIQUEL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3620
Mailing Address - Country:US
Mailing Address - Phone:808-209-0897
Mailing Address - Fax:
Practice Address - Street 1:1679 E MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5253
Practice Address - Country:US
Practice Address - Phone:808-209-0897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)