Provider Demographics
NPI:1457665507
Name:COASTAL COUNSELING AND PLAY THERAPY CENTER, P.A.
Entity Type:Organization
Organization Name:COASTAL COUNSELING AND PLAY THERAPY CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-435-9090
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:GRANDY
Mailing Address - State:NC
Mailing Address - Zip Code:27939-0679
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6385 CARATOKE HWY
Practice Address - Street 2:
Practice Address - City:GRANDY
Practice Address - State:NC
Practice Address - Zip Code:27939-9617
Practice Address - Country:US
Practice Address - Phone:252-435-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-31
Last Update Date:2010-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6919101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty