| Coastal Community Counseling Services Llc | |
|
18 Coleman Pl Red Bank NJ 07701-6115 | |
| (732) 610-8396 | |
| Not Available |
| Full Name | Coastal Community Counseling Services Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 18 Coleman Pl, Red Bank, New Jersey |
| Authorized Official Name and Position | Kellie Illmensee (OWNER/DIRECTOR) |
| Authorized Official Contact | 7326108396 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Community Counseling Services Llc 18 Coleman Pl Red Bank NJ 07701-6115 Ph: (732) 610-8396 | Coastal Community Counseling Services Llc 18 Coleman Pl Red Bank NJ 07701-6115 Ph: (732) 610-8396 |
| NPI Number | 1790292787 |
|---|---|
| Provider Enumeration Date | 12/29/2017 |
| Last Update Date | 10/04/2022 |
| Certification Date | 10/04/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790292787 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 44SC05738600 (New Jersey) | Primary |
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