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General NPI Number Information
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NPI Number | 1083859318
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Entity Type | Organization
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Legal Business Name | COASTAL NEUROPSYCHIATRY, PA
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 12/16/2008
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Provider Practice Location Address
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Address Line | 132 PROFESSIONAL PARK DR SUITE B
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City | CONWAY
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State | SC
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Zip | 29526-9260
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Country | US
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Telephone | 843-347-0356
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Fax | 843-347-0390
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Provider Business Mailing Address
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Address Line | 132 PROFESSIONAL PARK DR SUITE B
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City | CONWAY
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State | SC
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Zip | 29526-9260
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Country | US
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Telephone | 843-347-0356
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Fax | 843-347-0390
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. WILLIAM ARCHIE VAN HORN
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Credential | M.D.
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Telephone | 843-347-0356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 0TP-0100
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License Number State | SC
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