Provider Demographics
NPI:1609314293
Name:COASTAL HAVEN COUNSELING LLC
Entity Type:Organization
Organization Name:COASTAL HAVEN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:QUAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-945-0346
Mailing Address - Street 1:220 RONNIE CT STE 2
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4192
Mailing Address - Country:US
Mailing Address - Phone:843-945-0346
Mailing Address - Fax:843-432-3091
Practice Address - Street 1:220 RONNIE CT STE 2
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4192
Practice Address - Country:US
Practice Address - Phone:843-945-0346
Practice Address - Fax:843-432-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC6522251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty