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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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