Provider Demographics
NPI:1649650318
Name:COASTAL CAROLINA COUNSELING CENTER PA
Entity type:Organization
Organization Name:COASTAL CAROLINA COUNSELING CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCESCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALADINO
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC LCAS CSI
Authorized Official - Phone:704-806-3638
Mailing Address - Street 1:12006 ALABASTER CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:992 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2433
Practice Address - Country:US
Practice Address - Phone:704-806-3638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5496101Y00000X, 101YM0800X, 101YP2500X, 101YS0200X
NC1383101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103865Medicaid
NC6006421Medicaid