Healthcare Provider Details

I. General information

NPI: 1548390933
Provider Name (Legal Business Name): EAST COAST COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 LYNNDALE COURT SUITE C
GREENVILLE NC
27858
US

IV. Provider business mailing address

620 LYNNDALE COURT SUITE C
GREENVILLE NC
27858
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-8602
  • Fax: 252-752-8103
Mailing address:
  • Phone: 252-752-8602
  • Fax: 252-752-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL DENISE GENTILE
Title or Position: OWNER/CLINICAL DIRECTOR
Credential:
Phone: 252-752-8602