Provider Demographics
NPI:1720363328
Name:COASTAL PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:COASTAL PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:NAGELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:912-352-2992
Mailing Address - Street 1:322 STEPHENSON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5998
Mailing Address - Country:US
Mailing Address - Phone:912-352-2992
Mailing Address - Fax:912-352-3447
Practice Address - Street 1:322 STEPHENSON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5998
Practice Address - Country:US
Practice Address - Phone:912-352-2992
Practice Address - Fax:912-352-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000734103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty