Organization
COASTAL SUPPORT SPECIALISTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CAMILLUS (CASE) P. VAN DER KUIJL (FINANCIAL OFFICER)
(910) 233-1374
Entity
Organization
Contact information
Practice address
2460 DELANEY AVE, WILMINGTON, NC 28403-6062
(910) 792-6130
(910) 792-6132
Mailing address
2460 DELANEY AVE, WILMINGTON, NC 28403-6062
(910) 792-6130
(910) 792-6132
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
103T00000X
Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6008286
—
NC
05
—
8702029
—
NC
Enumeration date
01/03/2008
Last updated
08/16/2013
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