Provider Demographics
NPI:1891341806
Name:COASTAL WELLNESS, LLC
Entity type:Organization
Organization Name:COASTAL WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDOLENA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-965-6097
Mailing Address - Street 1:58 DEER TRL
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2110
Mailing Address - Country:US
Mailing Address - Phone:201-965-6097
Mailing Address - Fax:
Practice Address - Street 1:210 W FRONT ST STE 206A
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1155
Practice Address - Country:US
Practice Address - Phone:201-965-6097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty