# COASTAL CHRISTIAN COUNSELING

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

## Provider details

- **NPI number:** 1861162042
- **Authorized official:** MARLENA JANETTE PIQUE LCSW (OWNER/THERAPIST)
- **Authorized official phone:** (681) 242-7651

## Contact information

- **Practice address:** 112 BUENA VISTA DR, LONG BEACH, MS 39560-5703
- **Practice address phone:** (681) 242-7651
- **Mailing address:** 37 VANE DR, MARTINSBURG, WV 25403-0200
- **Mailing address phone:** (681) 242-7651

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 09/17/2021
- **Last updated:** 09/17/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | C9986 | CLINICAL SOCIAL WORK LICENSE | MS |