Provider Demographics
NPI:1871791939
Name:INTERCOASTAL COUNSELING SERVICES, INC.
Entity type:Organization
Organization Name:INTERCOASTAL COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GODWIN-ZUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-302-8353
Mailing Address - Street 1:660 LINTON BLVD
Mailing Address - Street 2:200 EX-1A
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-8167
Mailing Address - Country:US
Mailing Address - Phone:561-302-8353
Mailing Address - Fax:561-880-6982
Practice Address - Street 1:660 LINTON BLVD
Practice Address - Street 2:200 EX-1A
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-8167
Practice Address - Country:US
Practice Address - Phone:561-302-8353
Practice Address - Fax:561-880-6982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW30461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty