Healthcare Provider Details

I. General information

NPI: 1053294116
Provider Name (Legal Business Name): COASTAL COUNSELING AND ART THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MAINE ST SUITE 202
BRUNWICK ME
04011
US

IV. Provider business mailing address

14 MAINE ST SUITE 202 BOX 61
BRUNSWICK ME
04011
US

V. Phone/Fax

Practice location:
  • Phone: 207-332-8567
  • Fax:
Mailing address:
  • Phone: 207-332-8567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY C COULON
Title or Position: OWNER/COUNSELOR
Credential:
Phone: 207-332-8567