Provider Demographics
NPI:1346477403
Name:COASTAL SOUTHEASTERN UNITED CARE LLC
Entity Type:Organization
Organization Name:COASTAL SOUTHEASTERN UNITED CARE LLC
Other - Org Name:COASTAL SOUTHEASTERN UNITED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, HOME AND COMMUNITY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:843-806-2695
Mailing Address - Street 1:305 COMMERCE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557
Mailing Address - Country:US
Mailing Address - Phone:252-773-0195
Mailing Address - Fax:252-773-0214
Practice Address - Street 1:10 DOCTORS CIRCLE
Practice Address - Street 2:SUITE 6
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462
Practice Address - Country:US
Practice Address - Phone:910-755-5222
Practice Address - Fax:910-755-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302940Medicaid
NCB913OtherMEDICARE
NC8302940BMedicaid
NC8302940HMedicaid
NC8302940GMedicaid