Organization
COASTAL WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANA HISAW (OWNER)
(432) 889-5475
Entity
Organization
Contact information
Practice address
9929 SPID DR STE 113, CORPUS CHRISTI, TX 78418-5164
(432) 889-5475
Mailing address
9929 SPID DR STE 113, CORPUS CHRISTI, TX 78418-5164
(432) 889-5475
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
801800621
TX
Other
Enumeration date
08/29/2013
Last updated
08/29/2013
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