# COASTAL WELLNESS CLINIC APC

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

## Provider details

- **NPI number:** 1710718069
- **Authorized official:** JONATHON WHEATON (ADMINISTRATIVE OFFICER)
- **Authorized official phone:** (619) 782-0011

## Contact information

- **Practice address:** 2373 JEFFERSON ST, CARLSBAD, CA 92008-1405
- **Practice address phone:** (619) 782-0011
- **Mailing address:** 2358 UNIVERSITY AVE STE 371, SAN DIEGO, CA 92104-2720
- **Mailing address phone:** (619) 782-0011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/09/2024
- **Last updated:** 08/09/2024