Coastal Rehabilition Associates

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2564 Issued in NC

Legal business name

COASTAL REHABILITION ASSOCIATES

Practice address

2800 Ashton Dr
Suite 100
Wilmington, NC 28412-2575

Phone

(910) 794-8892

Fax

(910) 794-8895

NPI assigned

Apr 19, 2007

Organization subpart

No

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

Authorized official

Name

Steve Walters

Title

Administrator

Phone

(910) 794-8892

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316164775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4217",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284061217",
            "telephone_number": "910-794-8892",
            "fax_number": "910-794-8895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 ASHTON DR",
            "address_2": "SUITE 100",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122575",
            "telephone_number": "910-794-8892",
            "fax_number": "910-794-8895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL REHABILITION ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALTERS",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-794-8892"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "2564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "017XK",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005828",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Coastal Rehabilitation Associates
• Coastal Speech and Language PLLC
• Coastal Speech Therapy Inc
• Coastal Spine & Sports Medicine, PLLC
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• Coastal Support Specialists, Inc.

• Clinical Psychologist in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.