Provider Demographics
NPI:1013346816
Name:COASTAL FAMILY COUNSELING, LLC
Entity type:Organization
Organization Name:COASTAL FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:912-442-0558
Mailing Address - Street 1:191 OAK ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-6923
Mailing Address - Country:US
Mailing Address - Phone:912-442-0558
Mailing Address - Fax:
Practice Address - Street 1:150 BUTLER AVE STE D-3
Practice Address - Street 2:MIDWAY MINI MALL
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-4575
Practice Address - Country:US
Practice Address - Phone:912-442-0558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0030911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty