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General NPI Number Information
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NPI Number | 1457828253
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Entity Type | Organization
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Legal Business Name | COASTAL COMPREHENSIVE CARE PA
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 710 SUNSET BLVD N STE A
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City | SUNSET BEACH
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State | NC
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Zip | 28468-4340
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Country | US
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Telephone | 910-663-2273
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Fax | 910-663-4050
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Provider Business Mailing Address
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Address Line | PO BOX 2123
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City | BRYSON CITY
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State | NC
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Zip | 28713-5123
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Country | US
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Telephone | 910-490-0490
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Fax | 828-538-4441
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TERRESA A LONG
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Credential | NP
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Telephone | 910-663-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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