Organization
SHORELINE BEHAVIORAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN COFFIN ED (EXECUTIVE DIRECTOR)
(843) 365-8884
Entity
Organization
Contact information
Practice address
2404 WISE RD, CONWAY, SC 29526-5521
(843) 365-8884
Mailing address
2404 WISE ROAD, CONWAY, SC 29528
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
SC
251S00000X
Community/Behavioral Health Agency
Primary
57-0741188
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
57-0741188
—
SC
Enumeration date
01/22/2015
Last updated
01/22/2015
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