Provider Demographics
NPI:1376379644
Name:COASTAL CONNECTIONS COUNSELING INC
Entity type:Organization
Organization Name:COASTAL CONNECTIONS COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DULLECK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:303-419-0730
Mailing Address - Street 1:34921 US HIGHWAY 19 N STE 210
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1969
Mailing Address - Country:US
Mailing Address - Phone:727-476-7415
Mailing Address - Fax:
Practice Address - Street 1:34921 US HIGHWAY 19 N STE 210
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1969
Practice Address - Country:US
Practice Address - Phone:727-476-7415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty