Provider Demographics
NPI:1861883944
Name:ATLANTIC COASTAL THERAPY
Entity type:Organization
Organization Name:ATLANTIC COASTAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:RUBIN
Authorized Official - Last Name:MCGAUGHEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-658-8169
Mailing Address - Street 1:5 OGLETHORPE PROFESSIONAL BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3610
Mailing Address - Country:US
Mailing Address - Phone:912-658-8169
Mailing Address - Fax:678-658-9029
Practice Address - Street 1:5 OGLETHORPE PROFESSIONAL BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3610
Practice Address - Country:US
Practice Address - Phone:912-658-8169
Practice Address - Fax:678-658-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008060251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health