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General NPI Number Information
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NPI Number | 1790113520
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA BEHAVIORAL HEALTHCARE, LLC
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Dates
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Enumeration Date | 10/14/2013
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 108 HAY ST STE 303
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5684
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Country | US
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Telephone | 910-769-3575
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Fax |
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Provider Business Mailing Address
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Address Line | 3806 PARK AVE STE A
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City | WILMINGTON
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State | NC
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Zip | 28403-6739
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Country | US
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Telephone | 910-769-3575
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LARONDA WOODS FREEMAN
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Credential |
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Telephone | 910-769-3575
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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 |
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