Healthcare Provider Details

I. General information

NPI: 1720276868
Provider Name (Legal Business Name): COASTAL BEHAVIOR HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 STAMPER RD STE 201
FAYETTEVILLE NC
28303-4100
US

IV. Provider business mailing address

806 STAMPER RD STE 201
FAYETTEVILLE NC
28303-4100
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-8869
  • Fax: 910-491-9703
Mailing address:
  • Phone: 910-484-8869
  • Fax: 910-491-9703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number1720276868
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number1720276868
License Number StateNC

VIII. Authorized Official

Name: MRS. DUANA ANGELE MARSHALL
Title or Position: EXECUTIVE DIRECTOR/CEO
Credential: M.S., Q.P.
Phone: 910-484-8869