Provider Demographics
NPI:1497511828
Name:COASTAL WELLNESS LLC
Entity Type:Organization
Organization Name:COASTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY-EATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-597-0417
Mailing Address - Street 1:8196 CARMEL CIR
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-6935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2149 W 1ST ST UNIT 241
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36547-8412
Practice Address - Country:US
Practice Address - Phone:251-597-0417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health