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General NPI Number Information
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NPI Number | 1437322237
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Entity Type | Organization
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Legal Business Name | COASTAL COUNSELING & COACHING, INC
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 05/18/2008
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Provider Practice Location Address
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Address Line | 280 NEWPORT CENTER DR SUITE 200
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7526
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Country | US
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Telephone | 949-222-6688
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Fax | 949-716-7885
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Provider Business Mailing Address
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Address Line | 280 NEWPORT CENTER DR SUITE 200
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7526
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Country | US
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Telephone | 949-222-6688
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Fax | 949-716-7885
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. KATHLEEN ANNE NICKERSON
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Credential | PHD
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Telephone | 949-222-6688
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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 | 20446
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License Number State | CA
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