Healthcare Provider Details

I. General information

NPI: 1730002056
Provider Name (Legal Business Name): COASTAL TIDES COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 EAGLE CLAW DR
CALABASH NC
28467-3204
US

IV. Provider business mailing address

270 EAGLE CLAW DR
CALABASH NC
28467-3204
US

V. Phone/Fax

Practice location:
  • Phone: 845-522-1946
  • Fax:
Mailing address:
  • Phone: 845-522-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHELSEA GARCIA
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC, LCMHC
Phone: 845-522-1946