Organization
COASTAL THERAPY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACLYN MATHISEN LPC (OWNER)
(908) 295-4855
Entity
Organization
Contact information
Practice address
167 BLUFFTON RD STE I, BLUFFTON, SC 29910-6250
(908) 295-4855
Mailing address
25 DEERFIELD RD, HILTON HEAD ISLAND, SC 29926-1935
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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