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General NPI Number Information
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NPI Number | 1740417054
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Entity Type | Organization
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Legal Business Name | COASTAL DEVELOPMENTAL CONSULTING
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 308 GROVEDIERE LANE
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City | HAMPSTEAD
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State | NC
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Zip | 28443-2208
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Country | US
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Telephone | 910-431-6418
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Fax | 910-270-0270
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Provider Business Mailing Address
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Address Line | 308 GROVEDIERE LANE
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City | HAMPSTEAD
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State | NC
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Zip | 28443-2208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIANA KELLY
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Credential |
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Telephone | 910-270-0270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NC
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