Provider Demographics
NPI:1366679896
Name:COASTAL FAMILY SERVICES, PLLC
Entity Type:Organization
Organization Name:COASTAL FAMILY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT, LPC, NCC
Authorized Official - Phone:910-364-9709
Mailing Address - Street 1:PO BOX 27620
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5043
Mailing Address - Country:US
Mailing Address - Phone:910-364-9709
Mailing Address - Fax:877-604-9199
Practice Address - Street 1:5135 MORGANTON RD
Practice Address - Street 2:STE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1525
Practice Address - Country:US
Practice Address - Phone:910-364-9709
Practice Address - Fax:877-604-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6948101YP2500X
NC1295251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty