Provider Demographics
NPI:1417448010
Name:COASTAL INSPIRATIONS PLLC
Entity Type:Organization
Organization Name:COASTAL INSPIRATIONS PLLC
Other - Org Name:COASTAL INSPIRATIONS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:NABORS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-240-2220
Mailing Address - Street 1:3520 GLADEHILL LN
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-6511
Mailing Address - Country:US
Mailing Address - Phone:910-240-2220
Mailing Address - Fax:914-344-5746
Practice Address - Street 1:151 POOLE RD STE 505
Practice Address - Street 2:
Practice Address - City:BELVILLE
Practice Address - State:NC
Practice Address - Zip Code:28451-9508
Practice Address - Country:US
Practice Address - Phone:914-240-2220
Practice Address - Fax:914-344-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-20
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NCC-0094451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC9633OtherLICENSURE
NCC009445OtherLICENSURE
NY082236OtherLICENSURE