Provider Demographics
NPI:1932110541
Name:AZALEA COAST THERAPY, LLC
Entity Type:Organization
Organization Name:AZALEA COAST THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:ARTHURS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:910-794-4555
Mailing Address - Street 1:313 WALNUT ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4067
Mailing Address - Country:US
Mailing Address - Phone:910-794-4555
Mailing Address - Fax:910-794-9966
Practice Address - Street 1:313 WALNUT ST
Practice Address - Street 2:SUITE 18
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4067
Practice Address - Country:US
Practice Address - Phone:910-794-4555
Practice Address - Fax:910-794-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210807Medicaid
NC011TPOtherBCBS
NC=========OtherTRICARE