Provider Demographics
NPI:1851141212
Name:COASTAL CONNECTIONS COLLECTIVE, PLLC
Entity Type:Organization
Organization Name:COASTAL CONNECTIONS COLLECTIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CLEMENT BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:MAED, LCMHCA, NCC
Authorized Official - Phone:732-600-2582
Mailing Address - Street 1:1426 COMMONWEALTH DR # B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0302
Mailing Address - Country:US
Mailing Address - Phone:910-239-7244
Mailing Address - Fax:
Practice Address - Street 1:1426 COMMONWEALTH DR # B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0302
Practice Address - Country:US
Practice Address - Phone:910-239-7244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty