Organization
COASTAL COUNSELING & COACHING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHLEEN ANNE NICKERSON PHD (OWNER/PRESIDENT)
(949) 222-6688
Entity
Organization
Contact information
Practice address
280 NEWPORT CENTER DR, SUITE 200, NEWPORT BEACH, CA 92660-7526
(949) 222-6688
(949) 716-7885
Mailing address
280 NEWPORT CENTER DR, SUITE 200, NEWPORT BEACH, CA 92660-7526
(949) 222-6688
(949) 716-7885
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
20446
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20446
PSYCHOLOGY LICENSE - KFN
CA
01
—
C2942646
CA CORPORATION
CA
01
—
PSY20446A
MEDICARE - KFN
CA
Enumeration date
04/11/2008
Last updated
05/18/2008
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