Organization
COASTAL DETOX, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA TUCKER (CHIEF EXECUTIVE OFFICER)
(772) 219-1355
Entity
Organization
Contact information
Practice address
1131 SE INDIAN ST, STUART, FL 34997-5688
(772) 612-0130
Mailing address
3007 SW MARTIN DOWNS BLVD, PALM CITY, FL 34990-2644
Taxonomy
Speciality
Code
Description
License number
State
111NX0100X
Occupational Health Chiropractor
—
—
2084P0800X
Psychiatry Physician
—
—
225700000X
Massage Therapist
—
—
284300000X
Special Hospital
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
12/09/2015
Last updated
10/01/2024
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