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General NPI Number Information
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NPI Number | 1720276868
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Entity Type | Organization
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Legal Business Name | COASTAL BEHAVIOR HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 806 STAMPER RD STE 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4100
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Country | US
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Telephone | 910-484-8869
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Fax | 910-491-9703
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Provider Business Mailing Address
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Address Line | 806 STAMPER RD STE 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4100
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Country | US
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Telephone | 910-484-8869
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Fax | 910-491-9703
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/CEO
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Name | MRS. DUANA ANGELE MARSHALL
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Credential | M.S., Q.P.
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Telephone | 910-484-8869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 1720276868
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 1720276868
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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