Provider Demographics
NPI:1922886043
Name:COASTLINE FAMILY COUNSELING GROUP, CORP
Entity Type:Organization
Organization Name:COASTLINE FAMILY COUNSELING GROUP, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:760-525-2482
Mailing Address - Street 1:325 CARLSBAD VILLAGE DR STE F2
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2928
Mailing Address - Country:US
Mailing Address - Phone:760-525-2482
Mailing Address - Fax:
Practice Address - Street 1:325 CARLSBAD VILLAGE DR STE F2
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2928
Practice Address - Country:US
Practice Address - Phone:760-525-2482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty