Provider Demographics
NPI:1669210886
Name:COASTAL CONNECTIONS COUNSELING & CONSULTING SERVICES, LLC
Entity type:Organization
Organization Name:COASTAL CONNECTIONS COUNSELING & CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDON
Authorized Official - Middle Name:R
Authorized Official - Last Name:WASHINGTON TRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-356-2449
Mailing Address - Street 1:140 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-1370
Mailing Address - Country:US
Mailing Address - Phone:409-673-9890
Mailing Address - Fax:
Practice Address - Street 1:140 ALLEN ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-1370
Practice Address - Country:US
Practice Address - Phone:409-673-9890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-20
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty