Provider Demographics
NPI:1174254023
Name:CAROLINA COAST LACTATION, LLC
Entity Type:Organization
Organization Name:CAROLINA COAST LACTATION, LLC
Other - Org Name:CAROLINA COAST LACTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:AVILES-COREY
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:910-787-3670
Mailing Address - Street 1:807 TUSCARORA TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6402
Mailing Address - Country:US
Mailing Address - Phone:910-787-3670
Mailing Address - Fax:910-543-3893
Practice Address - Street 1:720 NEW BRIDGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5435
Practice Address - Country:US
Practice Address - Phone:910-787-3670
Practice Address - Fax:910-543-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty