Provider Demographics
NPI:1457678328
Name:COASTAL PSYCHOTHERAPY AND CONSULTING INC.
Entity Type:Organization
Organization Name:COASTAL PSYCHOTHERAPY AND CONSULTING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:843-298-4637
Mailing Address - Street 1:10 PINCKNEY COLONY RD
Mailing Address - Street 2:EXECUTIVE CENTER SUITE 315
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-4126
Mailing Address - Country:US
Mailing Address - Phone:843-298-4637
Mailing Address - Fax:877-248-2314
Practice Address - Street 1:10 PINCKNEY COLONY RD
Practice Address - Street 2:EXECUTIVE CENTER SUITE 315
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-4126
Practice Address - Country:US
Practice Address - Phone:843-298-4637
Practice Address - Fax:877-248-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC67601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ350950281Medicare PIN