=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477350130
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL WELLNESS COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2025
-----------------------------------------------------
Last Update Date | 03/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 908 BOSTON NECK RD APT 39
-----------------------------------------------------
City | NARRAGANSETT
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02882-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-714-4988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 908 BOSTON NECK RD APT 39
-----------------------------------------------------
City | NARRAGANSETT
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02882-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-714-4988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RACHEL MCCRYSTAL
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 401-684-8602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------