Healthcare Provider Details

I. General information

NPI: 1689597510
Provider Name (Legal Business Name): CRYSTAL COAST THERAPY COMPANY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N 35TH ST STE B
MOREHEAD CITY NC
28557-3183
US

IV. Provider business mailing address

209 N 35TH ST STE B
MOREHEAD CITY NC
28557-3183
US

V. Phone/Fax

Practice location:
  • Phone: 252-220-9088
  • Fax:
Mailing address:
  • Phone: 252-220-9088
  • 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: CHERYL A JACOBY
Title or Position: THERAPIST, OWNER
Credential: LCMHC
Phone: 252-892-8087