# COASTAL RIDGE HEALTH SERVICES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Deborah Jenks
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487133351
- **Authorized official:** DR. DEBORAH S JENKS DNP, PMHNP-BC, FNP (OWNER/EXECUTIVE DIRECTOR)
- **Authorized official phone:** (910) 821-1418

## Contact information

- **Practice address:** 14057 US HIGHWAY 17 STE 200, HAMPSTEAD, NC 28443-3793
- **Practice address phone:** (910) 821-1418
- **Practice address fax:** (866) 860-0997
- **Mailing address:** 14057 US HIGHWAY 17 STE 200, HAMPSTEAD, NC 28443-3793
- **Mailing address phone:** (910) 821-1418
- **Mailing address fax:** (866) 860-0997

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | 4461S | NC | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 0024175505 | VA | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 5009986 | NC | — |

## Other

- **Enumeration date:** 08/10/2018
- **Last updated:** 01/11/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0024175505 | VIRGINIA NP NUMBER | VA |
| 01 | — | 4461S | NORTH CAROLINA BOARD OF PROFESSIONAL COUNSELORS | NC |
| 01 | — | 5009986 | NORTH CAROLINA LICENSE NUMBER | NC |