Healthcare Provider Details

I. General information

NPI: 1295658599
Provider Name (Legal Business Name): COASTPRIDE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MAIN ST
HALF MOON BAY CA
94019-1721
US

IV. Provider business mailing address

255 MAIN ST
HALF MOON BAY CA
94019-1721
US

V. Phone/Fax

Practice location:
  • Phone: 650-808-7643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CARLY DEVLIN
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 650-808-7643