Provider Demographics
NPI:1245688720
Name:COASTAL COUNSELING AND THERAPY LLC
Entity type:Organization
Organization Name:COASTAL COUNSELING AND THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MARIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:850-250-2579
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32457-0384
Mailing Address - Country:US
Mailing Address - Phone:850-250-2579
Mailing Address - Fax:813-262-0999
Practice Address - Street 1:304 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1846
Practice Address - Country:US
Practice Address - Phone:850-250-2579
Practice Address - Fax:813-262-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty