Coastal Carolina University Counseling Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

COASTAL CAROLINA UNIVERSITY COUNSELING SERVICES

Practice address

204 University Blvd.
Conway, SC 29528-6054

Phone

(843) 349-2305

Fax

(843) 349-2898

NPI assigned

Mar 16, 2007

Last updated

Aug 22, 2020By 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

Dr. Jennie M. Cassidy, PH.D.NPI 1184752495

Title

Director

Phone

(843) 349-2305

Specialties & licenses 1

Addresses

Tax ID family

Coastal Carolina University Counseling Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Coastal Carolina University Student Health Services

  • Student Health Clinic/Center
  • Conway, SC
  • NPI 1083800858
  NPD tax ID

Locations

Practitioners 1

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.

• Jennie May Cassidy, PH.D.

  • Group Psychotherapy Psychologist
  • Conway, SC
  • NPI 1184752495
  Authorized official Same address or phone

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780718130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 UNIVERSITY BLVD.",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295286054",
            "telephone_number": "843-349-2305",
            "fax_number": "843-349-2898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 UNIVERSITY BLVD.",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295286054",
            "telephone_number": "843-349-2305",
            "fax_number": "843-349-2898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA UNIVERSITY COUNSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CASSIDY",
        "authorized_official_first_name": "JENNIE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "843-349-2305",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coastal Carolina Centers of Urology and Surgery LLC (Rivertown Surgery Center)
• Coastal Carolina Centers of Urology and Surgery LLC (Rivertown Surgery Center)
• Coastal Carolina OB GYN LLC
• Coastal Carolina Physical Rehab Inc
• Coastal Carolina University
• Coastal Carolina University Student Health Services
• Coastal Family Medicine
• Coastal Home Care (American HomePatient)
• Coastal Kidney Center PA
• Coastal Mind Over Matter LLC

• Community/Behavioral Health Agency in Conway, SC
• Providers in Conway, SC by specialty
• Community/Behavioral Health Agency in South 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.