| Coastal Carolina Behavioral Health, Inc. | |
|
2734 Beaver Run Blvd Unit D Surfside Beach SC 29575-5392 | |
| (843) 650-1085 | |
| (843) 650-1088 |
| Full Name | Coastal Carolina Behavioral Health, Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2734 Beaver Run Blvd Unit D, Surfside Beach, South Carolina |
| Authorized Official Name and Position | Samantha Giermann (OFFICE MANAGER) |
| Authorized Official Contact | 9103824082 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Carolina Behavioral Health, Inc. 2734 Beaver Run Blvd Unit D Surfside Beach SC 29575-5392 Ph: (843) 650-1085 | Coastal Carolina Behavioral Health, Inc. 2734 Beaver Run Blvd Unit D Surfside Beach SC 29575-5392 Ph: (843) 650-1085 |
| NPI Number | 1811622277 |
|---|---|
| Provider Enumeration Date | 07/20/2022 |
| Last Update Date | 02/06/2023 |
| Certification Date | 02/06/2023 |
| Medicare PECOS PAC ID | 1557734324 |
|---|---|
| Medicare Enrollment ID | O20230224001955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811622277 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Eric Mizelle |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780737072 PECOS PAC ID: 4486619103 Enrollment ID: I20230224002497 |
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