Healthcare Provider Details

I. General information

NPI: 1679729503
Provider Name (Legal Business Name): COASTAL NEUROPSYCHOLOGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7655 MARKET ST
WILMINGTON NC
28411-9458
US

IV. Provider business mailing address

7655 MARKET ST
WILMINGTON NC
28411-9458
US

V. Phone/Fax

Practice location:
  • Phone: 910-681-3880
  • Fax: 910-681-3885
Mailing address:
  • Phone: 910-681-3880
  • Fax: 910-681-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY L JONES
Title or Position: PSYCHOLOGIST/OWNER
Credential: PH.D.
Phone: 910-681-3880