Healthcare Provider Details

I. General information

NPI: 1922153063
Provider Name (Legal Business Name): COASTAL HORIZONS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

IV. Provider business mailing address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER L MIGLIOSI
Title or Position: SUBSTANCE ABUSE COUNSELOR
Credential: MS, LPC, NCC
Phone: 910-343-0145