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General NPI Number Information
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NPI Number | 1598005712
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Entity Type | Organization
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Legal Business Name | COASTAL COUNSELING
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 2910 JEFFERSON ST SUITE 201
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City | CARLSBAD
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State | CA
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Zip | 92008-2356
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Country | US
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Telephone | 888-470-4415
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Fax | 760-407-9916
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Provider Business Mailing Address
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Address Line | 2910 JEFFERSON ST SUITE 201
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City | CARLSBAD
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State | CA
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Zip | 92008-2356
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Country | US
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Telephone | 888-470-4415
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Fax | 760-407-9916
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Authorized Official
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Title or Position | COO
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Name | MR. ANDREW WILSON
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Credential |
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Telephone | 760-583-5781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS23587
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License Number State | CA
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