Provider Demographics
NPI:1720276868
Name:COASTAL BEHAVIOR HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:COASTAL BEHAVIOR HEALTH SERVICES, INC.
Other - Org Name:CBHS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DUANA
Authorized Official - Middle Name:ANGELE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, QP
Authorized Official - Phone:910-484-8869
Mailing Address - Street 1:806 STAMPER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4100
Mailing Address - Country:US
Mailing Address - Phone:910-484-8869
Mailing Address - Fax:910-491-9703
Practice Address - Street 1:806 STAMPER RD STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4100
Practice Address - Country:US
Practice Address - Phone:910-484-8869
Practice Address - Fax:910-491-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NC1720276868253J00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness