Healthcare Provider Details

I. General information

NPI: 1922189679
Provider Name (Legal Business Name): COASTAL SAMARITAN COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 PROFESSIONAL DRIVE STE 101
MYRTLE BEACH SC
29577-5713
US

IV. Provider business mailing address

1297 PROFESSIONAL DR STE 101
MYRTLE BEACH SC
29577-5713
US

V. Phone/Fax

Practice location:
  • Phone: 843-448-4820
  • Fax: 843-448-9875
Mailing address:
  • Phone: 843-448-4820
  • Fax: 843-448-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierGP7630
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: DR. MELINDA P TAVERNIER
Title or Position: EXECUTIVE DIRECTOR
Credential: EDD
Phone: 843-448-4820