Healthcare Provider Details

I. General information

NPI: 1295013985
Provider Name (Legal Business Name): COASTAL COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 BAY AVE SUITE 2
POINT PLEASANT BORO NJ
08742-4502
US

IV. Provider business mailing address

1648 BAY AVE SUITE 2
POINT PLEASANT BORO NJ
08742-4502
US

V. Phone/Fax

Practice location:
  • Phone: 732-600-1306
  • Fax: 732-899-6962
Mailing address:
  • Phone: 732-600-1306
  • Fax: 732-899-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05471200
License Number StateNJ

VIII. Authorized Official

Name: MS. TERRY LARKIN
Title or Position: PSYCHOTHERAPIST
Credential: MSW, LCSW
Phone: 732-600-1306