Provider Demographics
NPI:1295013985
Name:COASTAL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:COASTAL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:732-600-1306
Mailing Address - Street 1:1648 BAY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4502
Mailing Address - Country:US
Mailing Address - Phone:732-600-1306
Mailing Address - Fax:732-899-6962
Practice Address - Street 1:1648 BAY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-4502
Practice Address - Country:US
Practice Address - Phone:732-600-1306
Practice Address - Fax:732-899-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054712001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty