Provider Demographics
NPI:1477006021
Name:OCEANSIDE FAMILY COUNSELING AND RESOURCE CENTER, PLLC
Entity type:Organization
Organization Name:OCEANSIDE FAMILY COUNSELING AND RESOURCE CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROWN-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCAI LCASA
Authorized Official - Phone:910-234-2824
Mailing Address - Street 1:710 SUNSET BLVD N STE D
Mailing Address - Street 2:
Mailing Address - City:SUNSET BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28468-4340
Mailing Address - Country:US
Mailing Address - Phone:910-575-4200
Mailing Address - Fax:910-575-4201
Practice Address - Street 1:104 SUMMER LN
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-8757
Practice Address - Country:US
Practice Address - Phone:910-234-2824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20495101YA0400X
NCA11182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1730585282OtherNPI