Provider Demographics
NPI:1861144982
Name:INTRACOASTAL COUNSELING & CONSULTING, PLLC
Entity type:Organization
Organization Name:INTRACOASTAL COUNSELING & CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEMPLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-571-7235
Mailing Address - Street 1:12736 PETREL XING
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2959
Mailing Address - Country:US
Mailing Address - Phone:252-571-7235
Mailing Address - Fax:252-631-0344
Practice Address - Street 1:12736 PETREL XING
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2959
Practice Address - Country:US
Practice Address - Phone:252-571-7235
Practice Address - Fax:252-631-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty