Organization Name: | COASTAL SOUTHEASTERN UNITED CARE LLC |
NPI Number: | 1346477403 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STACY WILLIAMSON (DIRECTOR) |
Mailing Address: | 3640 Express Dr Shallotte |
State: | NC US |
Postal Code: | 284706501 |
Phone Number: | 9107555222 |
Fax Number: | 9107555255 |
NPI Enumeration Date: | 06/16/2009 |
NPI Last Update Date: | 04/04/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |