Provider Demographics
NPI:1588771935
Name:COASTAL COUNSELING ASSOCIATES, LLC
Entity type:Organization
Organization Name:COASTAL COUNSELING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-245-1956
Mailing Address - Street 1:149 DURHAM RD STE 31
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2664
Mailing Address - Country:US
Mailing Address - Phone:203-245-1956
Mailing Address - Fax:203-245-6710
Practice Address - Street 1:149 DURHAM RD STE 31
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2664
Practice Address - Country:US
Practice Address - Phone:203-245-1956
Practice Address - Fax:203-245-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)