Healthcare Provider Details

I. General information

NPI: 1255978128
Provider Name (Legal Business Name): COASTAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 HWY 33 W
CHOCOWINITY NC
27817
US

IV. Provider business mailing address

PO BOX 644
CHOCOWINITY NC
27817-0644
US

V. Phone/Fax

Practice location:
  • Phone: 252-256-7219
  • Fax:
Mailing address:
  • Phone: 252-256-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: NIADRA BLOUNT PRATT
Title or Position: THERAPIST
Credential: MS, LCAS, CCS, LPCA
Phone: 252-256-7219