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General NPI Number Information
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NPI Number | 1366679896
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Entity Type | Organization
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Legal Business Name | COASTAL FAMILY SERVICES, PLLC
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 5135 MORGANTON RD STE 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-1525
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Country | US
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Telephone | 910-364-9709
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Fax | 877-604-9199
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Provider Business Mailing Address
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Address Line | PO BOX 27620
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5043
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Country | US
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Telephone | 910-364-9709
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Fax | 877-604-9199
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Authorized Official
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Title or Position | CEO
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Name | MR. ERIC A. WILLIAMS
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Credential | MS, LMFT, LPC, NCC
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Telephone | 910-364-9709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6948
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1295
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License Number State | NC
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