Provider Demographics
NPI:1184855876
Name:COASTAL ADOLESCENT BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:COASTAL ADOLESCENT BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRABER LAZAROVICI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-849-9009
Mailing Address - Street 1:1135 BOWMAN RD STE 529C
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3205
Mailing Address - Country:US
Mailing Address - Phone:843-849-9009
Mailing Address - Fax:
Practice Address - Street 1:1135 BOWMAN RD STE 529C
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3205
Practice Address - Country:US
Practice Address - Phone:843-849-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31462261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health