Provider Demographics
NPI:1447488945
Name:COASTAL AUTISM THERAPY CENTER, INC.
Entity type:Organization
Organization Name:COASTAL AUTISM THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC, BCBA
Authorized Official - Phone:912-507-1553
Mailing Address - Street 1:130 CANAL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4091
Mailing Address - Country:US
Mailing Address - Phone:912-507-1553
Mailing Address - Fax:912-443-9004
Practice Address - Street 1:110 PIPEMAKERS CIR STE 116
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4168
Practice Address - Country:US
Practice Address - Phone:912-330-7171
Practice Address - Fax:888-413-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health