Provider Demographics
NPI:1427788561
Name:GOLD COAST CONSULTING LLC
Entity type:Organization
Organization Name:GOLD COAST CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-709-9021
Mailing Address - Street 1:101 DEVANT ST STE 503
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2720
Mailing Address - Country:US
Mailing Address - Phone:770-282-6962
Mailing Address - Fax:
Practice Address - Street 1:101 DEVANT ST STE 503
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2720
Practice Address - Country:US
Practice Address - Phone:770-282-6962
Practice Address - Fax:770-282-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000000000000000OtherNOT APPLICABLE