Healthcare Provider Details

I. General information

NPI: 1659901445
Provider Name (Legal Business Name): COASTAL COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LOBSTER LN
CHATHAM MA
02633-2580
US

IV. Provider business mailing address

2 EARLY RED CIR
SANDWICH MA
02563-2681
US

V. Phone/Fax

Practice location:
  • Phone: 917-825-4088
  • Fax:
Mailing address:
  • Phone: 973-922-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA D'ACOASTA
Title or Position: OWNER
Credential: LICSW
Phone: 973-922-3551