Provider Demographics
NPI:1598005712
Name:COASTAL COUNSELING
Entity Type:Organization
Organization Name:COASTAL COUNSELING
Other - Org Name:JENNIFER SEMMES
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-583-5781
Mailing Address - Street 1:2910 JEFFERSON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2356
Mailing Address - Country:US
Mailing Address - Phone:888-470-4415
Mailing Address - Fax:760-407-9916
Practice Address - Street 1:2910 JEFFERSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2356
Practice Address - Country:US
Practice Address - Phone:888-470-4415
Practice Address - Fax:760-407-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS235871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty