Healthcare Provider Details

I. General information

NPI: 1326173253
Provider Name (Legal Business Name): COASTAL COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FRONT ST STE 2
EXETER NH
03833-2727
US

IV. Provider business mailing address

24 FRONT ST STE 2
EXETER NH
03833-2727
US

V. Phone/Fax

Practice location:
  • Phone: 603-778-0505
  • Fax:
Mailing address:
  • Phone: 603-778-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number136
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number95
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number606
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number94
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number245
License Number StateNH
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number188
License Number StateNH

VIII. Authorized Official

Name: PROF. KATHRYN FORBES-FISHER
Title or Position: PARTNER
Credential: LICSW
Phone: 603-778-0505