Healthcare Provider Details

I. General information

NPI: 1346477403
Provider Name (Legal Business Name): COASTAL SOUTHEASTERN UNITED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 09/02/2025
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DOCTORS CIRCLE SUITE 6
SUPPLY NC
28462
US

IV. Provider business mailing address

305 COMMERCE AVE SUITE 102
MOREHEAD CITY NC
28557
US

V. Phone/Fax

Practice location:
  • Phone: 910-755-5222
  • Fax: 910-755-5255
Mailing address:
  • Phone: 252-773-0195
  • Fax: 252-773-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. SHANNON ASHLEY ATKINSON
Title or Position: VP, HOME AND COMMUNITY SERVICES
Credential: LCSW
Phone: 843-806-2695