Provider Demographics
NPI:1164130167
Name:EMERALD COAST HEALING CENTER, LLC
Entity Type:Organization
Organization Name:EMERALD COAST HEALING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EPPOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-684-5566
Mailing Address - Street 1:1910 NAVARRE SCHOOL RD UNIT 5277
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-6412
Mailing Address - Country:US
Mailing Address - Phone:850-684-5566
Mailing Address - Fax:850-546-4588
Practice Address - Street 1:8536 HIGH SCHOOL BLVD
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-3218
Practice Address - Country:US
Practice Address - Phone:850-684-5566
Practice Address - Fax:850-546-4588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)