Provider Demographics
NPI:1578231577
Name:COASTAL THERAPY CENTER LLC
Entity Type:Organization
Organization Name:COASTAL THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:KLOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCAS
Authorized Official - Phone:919-439-9467
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-1328
Mailing Address - Country:US
Mailing Address - Phone:919-439-9467
Mailing Address - Fax:
Practice Address - Street 1:9101 COLEWAY DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-4463
Practice Address - Country:US
Practice Address - Phone:919-439-9467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty