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General NPI Number Information
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NPI Number | 1174076780
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Entity Type | Organization
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Legal Business Name | OCEANSIDE COUNSELING LPC PC
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Dates
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Enumeration Date | 07/31/2016
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Last Update Date | 07/31/2016
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Provider Practice Location Address
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Address Line | 130 N HAMPTON RD
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City | WILMINGTON
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State | NC
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Zip | 28409-3181
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Country | US
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Telephone | 910-742-1791
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Fax | 910-339-4045
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Provider Business Mailing Address
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Address Line | 130 N HAMPTON RD
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City | WILMINGTON
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State | NC
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Zip | 28409-3181
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Country | US
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Telephone | 910-742-1791
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Fax | 910-339-4045
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Authorized Official
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Title or Position | PRESIDENT
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Name | JARROD GRAY
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Credential | LPC
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Telephone | 910-742-1791
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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 | 4576
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License Number State | NC
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