Healthcare Provider Details

I. General information

NPI: 1619885779
Provider Name (Legal Business Name): COASTAL EMPIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 RIBAUT RD
BEAUFORT SC
29902-5400
US

IV. Provider business mailing address

1050 RIBAUT RD
BEAUFORT SC
29902-5400
US

V. Phone/Fax

Practice location:
  • Phone: 843-524-8899
  • Fax:
Mailing address:
  • Phone: 843-524-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TARSAE YEVETTE LITTLE
Title or Position: SOCIAL WORKER
Credential: MSW
Phone: 424-355-5911