Healthcare Provider Details

I. General information

NPI: 1922886043
Provider Name (Legal Business Name): COASTLINE FAMILY COUNSELING GROUP, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CARLSBAD VILLAGE DR STE F2
CARLSBAD CA
92008-2928
US

IV. Provider business mailing address

325 CARLSBAD VILLAGE DR STE F2
CARLSBAD CA
92008-2928
US

V. Phone/Fax

Practice location:
  • Phone: 760-525-2482
  • Fax:
Mailing address:
  • Phone: 760-525-2482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA DENNISON
Title or Position: CEO/OWNER
Credential: LMFT
Phone: 760-525-2482