Healthcare Provider Details

I. General information

NPI: 1003787177
Provider Name (Legal Business Name): CLEAR COAST VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 MYRTLE ST
SARASOTA FL
34234-5931
US

IV. Provider business mailing address

1234 MYRTLE ST
SARASOTA FL
34234-5931
US

V. Phone/Fax

Practice location:
  • Phone: 310-623-2244
  • Fax:
Mailing address:
  • Phone: 310-623-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE ROBINSON
Title or Position: CEO
Credential:
Phone: 310-623-2244