Provider Demographics
NPI:1831320985
Name:COASTAL MENTAL HEALTH SERVICE PROVIDERS
Entity type:Organization
Organization Name:COASTAL MENTAL HEALTH SERVICE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DOUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-707-0516
Mailing Address - Street 1:104 WINNER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-4801
Mailing Address - Country:US
Mailing Address - Phone:910-707-0516
Mailing Address - Fax:910-707-0516
Practice Address - Street 1:104 WINNER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-4801
Practice Address - Country:US
Practice Address - Phone:910-707-0516
Practice Address - Fax:910-707-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health