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Organization

COASTAL RESIDENTIAL SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CAROL WILSON (VICE PRESIDENT)
(910) 938-9550
Entity
Organization

Contact information

Practice address
445 WESTERN BLVD STE T, JACKSONVILLE, NC 28546-6852
(910) 938-9550
(910) 346-9186
Mailing address
PO BOX 7128, JACKSONVILLE, NC 28540-2128
(910) 938-9550
(910) 938-5912

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
09/12/2007
Last updated
11/18/2020
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