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General NPI Number Information
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NPI Number | 1922886043
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Entity Type | Organization
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Legal Business Name | COASTLINE FAMILY COUNSELING GROUP, CORP
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 325 CARLSBAD VILLAGE DR STE F2
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City | CARLSBAD
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State | CA
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Zip | 92008-2928
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Country | US
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Telephone | 760-525-2482
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Fax |
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Provider Business Mailing Address
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Address Line | 325 CARLSBAD VILLAGE DR STE F2
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City | CARLSBAD
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State | CA
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Zip | 92008-2928
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Country | US
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Telephone | 760-525-2482
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | REBECCA DENNISON
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Credential | LMFT
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Telephone | 760-525-2482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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