Organization
COASTAL CENTER FOR COGNITIVE THERAPY, PA
Active
Organization
COASTAL CENTER FOR COGNITIVE THERAPY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL M. GRANT PH.D. (PRESIDENT/SECRETARY)
(843) 839-9028
Entity
Organization
Contact information
Practice address
1101 JOHNSON AVE, SUITE 200, MYRTLE BEACH, SC 29577-1660
(843) 839-9028
(843) 839-9029
Mailing address
1101 JOHNSON AVE, SUITE 200, MYRTLE BEACH, SC 29577-1660
(843) 839-9028
(843) 839-9029
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1071
SC
Other
Enumeration date
01/10/2008
Last updated
03/06/2009
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