Organization
COASTAL CAROLINA BEHAVIORAL HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN ANDREW TRAYLOR (PRESIDENT)
(910) 640-3535
Entity
Organization
Contact information
Practice address
603 S MADISON ST, WHITEVILLE, NC 28472-4129
(910) 640-3535
(910) 640-3538
Mailing address
603 S MADISON ST, WHITEVILLE, NC 28472-4129
(910) 640-3535
(910) 640-3538
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3410191
—
NC
05
—
6008752
—
NC
05
—
6604437
—
NC
05
—
8301226
—
NC
05
—
8301226B
—
NC
05
—
8301226H
—
NC
05
—
8301226V
—
NC
Enumeration date
03/28/2012
Last updated
01/06/2014
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