Provider Demographics
NPI:1922743848
Name:FRIENDS OF COASTAL GA LLC
Entity Type:Organization
Organization Name:FRIENDS OF COASTAL GA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:MARANDA
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:888-508-1012
Mailing Address - Street 1:528 GOLDEN GROVE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-5908
Mailing Address - Country:US
Mailing Address - Phone:888-508-1012
Mailing Address - Fax:888-558-9897
Practice Address - Street 1:528 GOLDEN GROVE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-5908
Practice Address - Country:US
Practice Address - Phone:888-508-1012
Practice Address - Fax:888-558-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health