Provider Demographics
NPI:1942648043
Name:COASTAL SERENITY PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:COASTAL SERENITY PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-602-9096
Mailing Address - Street 1:201 CANAAN CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5280
Mailing Address - Country:US
Mailing Address - Phone:814-602-9096
Mailing Address - Fax:910-346-1054
Practice Address - Street 1:824 GUM BRANCH RD
Practice Address - Street 2:SUITE Q
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6272
Practice Address - Country:US
Practice Address - Phone:814-602-9096
Practice Address - Fax:910-346-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-001752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty