Healthcare Provider Details

I. General information

NPI: 1962307918
Provider Name (Legal Business Name): COASTAL STREAM COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 GRAYSON AVE
SAVANNAH GA
31419-8147
US

IV. Provider business mailing address

168 GRAYSON AVE
SAVANNAH GA
31419-8147
US

V. Phone/Fax

Practice location:
  • Phone: 478-484-6991
  • Fax:
Mailing address:
  • Phone: 478-484-6991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: EARNESTINE HILSON RAINEY
Title or Position: CEO
Credential: LPC, LMHC, NCC
Phone: 478-484-6991