Provider Demographics
NPI:1841692076
Name:CAROLINA COAST SPEECH THERAPY, PLLC
Entity type:Organization
Organization Name:CAROLINA COAST SPEECH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:NATIONS
Authorized Official - Last Name:FLYNT
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:910-325-3318
Mailing Address - Street 1:3907 WRIGHTSVILLE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6247
Mailing Address - Country:US
Mailing Address - Phone:910-352-3318
Mailing Address - Fax:910-799-7119
Practice Address - Street 1:3907 WRIGHTSVILLE AVE STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6247
Practice Address - Country:US
Practice Address - Phone:910-352-3318
Practice Address - Fax:910-799-7119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty