Organization
COASTAL REHABILITION ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE WALTERS (ADMINISTRATOR)
(910) 794-8892
Entity
Organization
Contact information
Practice address
2800 ASHTON DR, SUITE 100, WILMINGTON, NC 28412-2575
(910) 794-8892
(910) 794-8895
Mailing address
PO BOX 4217, WILMINGTON, NC 28406-1217
(910) 794-8892
(910) 794-8895
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2564
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017XK
BCBS GROUP
NC
05
—
6005828
—
NC
Enumeration date
04/19/2007
Last updated
08/22/2020
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