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General NPI Number Information
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NPI Number | 1699089516
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA NEUROPSYCHIATRIC CRISIS SERVICES, PA
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 117 BEASLEY STREET
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City | KENANSVILLE
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State | NC
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Zip | 28349-0000
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Country | US
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Telephone | 910-275-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 200 TARPON TRL
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City | JACKSONVILLE
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State | NC
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Zip | 28546-5287
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Country | US
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Telephone | 910-275-0222
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. ASHRAF G MIKHAIL
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Credential | MD
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Telephone | 910-275-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | NC
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