Organization
COASTAL ADDICTION RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JODI MOORE (EXECUTIVE ADMINISTRATOR)
(864) 303-2499
Entity
Organization
Contact information
Practice address
2179 ASHLEY PHOSPHATE RD STE B, NORTH CHARLESTON, SC 29406-4180
(843) 718-3168
Mailing address
2179 ASHLEY PHOSPHATE RD STE B, NORTH CHARLESTON, SC 29406-4180
(843) 718-3168
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
Other
Enumeration date
02/27/2018
Last updated
02/27/2018
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