Provider Demographics
NPI:1831422005
Name:PATHFINDERS OF COASTAL CAROLINA, INC.
Entity type:Organization
Organization Name:PATHFINDERS OF COASTAL CAROLINA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-251-2311
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:ROPER
Mailing Address - State:NC
Mailing Address - Zip Code:27970-0097
Mailing Address - Country:US
Mailing Address - Phone:252-793-3057
Mailing Address - Fax:252-793-3148
Practice Address - Street 1:301 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-1521
Practice Address - Country:US
Practice Address - Phone:252-793-3057
Practice Address - Fax:252-793-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health