NPIMap

Organization Active NPI

Coastal Neurotherapy, P.a.

  • Clinical Neuropsychologist
  • Jacksonville, NC
National Provider Identifier
1528353729
Registry record updated Jun 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
3745 Issued in NC
Legal business name
COASTAL NEUROTHERAPY, P.A.
Practice address
200 Valencia Dr
Suite 109
Jacksonville, NC 28546-6311
Phone
(910) 353-1760
NPI assigned
Jun 15, 2011
Last updated
Jun 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2011

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

Authorized official

Name
David Hagedorn, PH.D.NPI 1992906747
Title
President/Owner
Phone
(910) 353-1760

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 3745 NC Primary

Addresses

Primary practice location

200 Valencia Dr
Suite 109
Jacksonville, NC 28546-6311

Mailing address

200 Valencia Dr
Suite 109
Jacksonville, NC 28546-6311

National Provider Directory

National Provider Directory

Locations

200 Valencia Dr
Ste 109
Jacksonville, NC 28546
Phone (910) 330-7559

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308096000000",
    "number": "1528353729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 VALENCIA DR",
            "address_2": "SUITE 109",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 VALENCIA DR",
            "address_2": "SUITE 109",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466311",
            "telephone_number": "910-353-1760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL NEUROTHERAPY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-15",
        "last_updated": "2011-06-15",
        "status": "A",
        "authorized_official_last_name": "HAGEDORN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "910-353-1760",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NC",
            "license": "3745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2011; 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.