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Organization
COASTAL SUPPORT SPECIALISTS, INC.
Active
Organization
COASTAL SUPPORT SPECIALISTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CAMILLUS (CASE) P. VAN DER KUIJL (FINANCIAL OFFICER)
(910) 233-1374
Entity
Organization
Contact information
Practice address
2460 DELANEY AVE, WILMINGTON, NC 28403-6062
(910) 792-6130
(910) 792-6132
Mailing address
2460 DELANEY AVE, WILMINGTON, NC 28403-6062
(910) 792-6130
(910) 792-6132
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
103T00000X
Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6008286
—
NC
05
—
8702029
—
NC
Enumeration date
01/03/2008
Last updated
08/16/2013
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