Coastal Carolina Behavioral Healthcare LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

COASTAL CAROLINA BEHAVIORAL HEALTHCARE LLC

Practice address

603 S Madison St
Whiteville, NC 28472-4129

Phone

(910) 640-3535

Fax

(910) 640-3538

NPI assigned

Mar 28, 2012

Last updated

Jan 6, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jonathan Andrew TraylorNPI 1841536281

Title

President

Phone

(910) 640-3535

Specialties & licenses 1

Addresses

Other identifiers 7

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jonathan Andrew Traylor, LPC, LCAS, NCC

  • Mental Health Counselor
  • Whiteville, NC
  • NPI 1841536281
  NPD (past) Authorized official
• Latricia Lynn Freeman, LCSW

  • Clinical Social Worker
  • Fairmont, NC
  • NPI 1790124501
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388966400000",
    "number": "1184990863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 S MADISON ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284724129",
            "telephone_number": "910-640-3535",
            "fax_number": "910-640-3538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 S MADISON ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284724129",
            "telephone_number": "910-640-3535",
            "fax_number": "910-640-3538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA BEHAVIORAL HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-28",
        "last_updated": "2014-01-06",
        "status": "A",
        "authorized_official_last_name": "TRAYLOR",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-640-3535"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301226H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301226V",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604437",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6008752",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3410191",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301226",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301226B",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Davisha Shaquan Clarida
• Jeffrey Alan Clarke, PA
• Delone Yvette Cleare, O.T.
• Cathy M Cliff, CFM
• Coastal Carolina Anesthesiologist, P.a.
• Coastal Carolina ENT DO PA
• Coastal Carolina Neonatology, PLLC (CCN-Whiteville)
• Coastal Community Management LLC
• Coastal Comprehensive Care PA
• Coastal Family Urgent Care, P.a.

• Community/Behavioral Health Agency in Whiteville, NC
• Providers in Whiteville, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.