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Organization
COASTAL INTENSIVE SERVICES
Active
Organization
COASTAL INTENSIVE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH VON COLDITZ (OWNER)
(503) 789-6850
Entity
Organization
Contact information
Practice address
3880 SE 8TH AVE, PORTLAND, OR 97202-3772
(503) 789-6850
Mailing address
5 N HIGHWAY 101, WARRENTON, OR 97146-9313
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104224393
—
OR
01
—
1770810723
OTHER
—
Enumeration date
07/19/2024
Last updated
07/19/2024
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