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General NPI Number Information
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NPI Number | 1114180023
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Entity Type | Organization
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Legal Business Name | COASTAL THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 3005 A SOUTH MEMORIAL DR
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City | GREENVILLE
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State | NC
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Zip | 27834-6224
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Country | US
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Telephone | 252-439-0701
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Fax | 252-439-0576
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Provider Business Mailing Address
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Address Line | 3005A SOUTH MEMORIAL DRIVE
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City | GREENVILLE
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State | NC
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Zip | 27834-6224
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Country | US
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Telephone | 252-439-0701
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Fax | 252-439-0576
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Authorized Official
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Title or Position | CEO
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Name | EUMEKA S DUDLEY
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Credential |
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Telephone | 252-948-0701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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