Provider Demographics
NPI:1396150611
Name:COASTAL CAR
Entity type:Organization
Organization Name:COASTAL CAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:TAQUICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA
Authorized Official - Phone:910-620-8301
Mailing Address - Street 1:1003 ST. ANDREWS DRIVE
Mailing Address - Street 2:APT. #103
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:609 SHIPYARD BLVD
Practice Address - Street 2:UNIT 102
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6562
Practice Address - Country:US
Practice Address - Phone:910-620-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP008674251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health