=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033876792
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL COUNSELING & CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2021
-----------------------------------------------------
Last Update Date | 11/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23341 CROSS STREET
-----------------------------------------------------
City | ACCOMAC
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-709-4602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 922
-----------------------------------------------------
City | ACCOMAC
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23301-0922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-709-4602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SARAH LEWIS
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 757-709-4602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------