Organization
COASTAL SPEECH CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA O DICKERSON CCC-SLP (SPEECH PATHOLOGIST)
(910) 272-9056
Entity
Organization
Contact information
Practice address
210 LIBERTY HILL RD, LUMBERTON, NC 28358-2442
(910) 272-9056
(910) 272-9057
Mailing address
210 LIBERTY HILL RD, LUMBERTON, NC 28358-2442
(910) 272-9056
(910) 272-9057
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3553
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28528
BCBS
NC
05
—
7211989
—
NC
Enumeration date
12/14/2006
Last updated
07/16/2013
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