Healthcare Provider Details

I. General information

NPI: 1437761699
Provider Name (Legal Business Name): COASTAL COUNSELING AND CONSULTING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31046 BEAVER CIRCLE
LEWES DE
19958
US

IV. Provider business mailing address

31046 BEAVER CIR
LEWES DE
19958-5581
US

V. Phone/Fax

Practice location:
  • Phone: 302-228-7285
  • Fax:
Mailing address:
  • Phone: 302-228-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KYMBERLY ALVARADO
Title or Position: CEO
Credential: LCSW
Phone: 302-228-7285