Healthcare Provider Details

I. General information

NPI: 1497919534
Provider Name (Legal Business Name): COASTAL COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 MERRITT BLVD SUITE D
DAPHNE AL
36526-4827
US

IV. Provider business mailing address

PO BOX 7627
MOBILE AL
36670-0627
US

V. Phone/Fax

Practice location:
  • Phone: 251-490-8186
  • Fax: 251-625-8719
Mailing address:
  • Phone: 251-633-7211
  • Fax: 251-410-6079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1105C
License Number StateAL

VIII. Authorized Official

Name: MISS PAMELA RAWDON
Title or Position: OWNER
Credential: LCSW
Phone: 251-490-8186