# COASTAL COUNSELING AND SUPERVISION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023810181
- **Authorized official:** LISA DIXON LISW-CP (OWNER)
- **Authorized official phone:** (443) 414-5910

## Contact information

- **Practice address:** 884 ALLBRITTON BLVD STE 110, MOUNT PLEASANT, SC 29464-3092
- **Practice address phone:** (434) 414-5910
- **Mailing address:** 1552 STRATHENE CT, MOUNT PLEASANT, SC 29466-9384
- **Mailing address phone:** (443) 414-5910

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 03/26/2025
- **Last updated:** 05/06/2025