Healthcare Provider Details

I. General information

NPI: 1982055273
Provider Name (Legal Business Name): COASTAL HORIZONS CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 OLEANDER DR
WILMINGTON NC
28403-6816
US

IV. Provider business mailing address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

V. Phone/Fax

Practice location:
  • Phone: 910-790-9949
  • Fax: 910-790-9455
Mailing address:
  • Phone: 910-343-0145
  • Fax: 910-341-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6005343
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARGARET WELLER STARGELL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 910-343-0145