COASTAL NEUROTHERAPY, P.A. (NPI# 1528353729) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528353729 |
| Entity Type | Organization |
| Organization Name | COASTAL NEUROTHERAPY, P.A. |
| Practice Address |
200 Valencia Dr Suite 109 Jacksonville NC 28546-6311 |
| Practice Telephone | 9103531760 |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2011-06-15 |
| Authorized Official Name | DAVID HAGEDORN (PRESIDENT/OWNER) |
| Authorized Official Telephone | 9103531760 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 3745 | NC | Behavioral Health & Social Service Providers |
| Street Address |
200 VALENCIA DR SUITE 109 |
| City | JACKSONVILLE |
| State | NC |
| Zip Code | 28546-6311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982688180 | Judith Tart Kettner | Counselor | 200 Valencia Dr, Suite 109, Jacksonville, NC 28546-7356 | 2005-12-01 |
| 1154797033 | Alpha Neurobehavioral Clinic | Counselor | 200 Valencia Dr, Suite 194, Jacksonville, NC 28546-6311 | 2015-08-14 |
| 1730584244 | Refuge Counseling & Consulting Services | Community/Behavioral Health | 200 Valencia Dr, Jacksonville, NC 28546-6311 | 2014-10-27 |
| 1649514605 | Brigita Sunshyne Baumgardner Lcsw Pa | Social Worker | 200 Valencia Dr, Suite 101, Jacksonville, NC 28546-6311 | 2012-11-15 |
| 1184900805 | Wilmina Beaumont Rosario | Counselor | 200 Valencia Dr, Jacksonville, NC 28546-6311 | 2011-10-26 |
| 1699050971 | Golden Gates Homecare Agency, LLC | In Home Supportive Care | 200 Valencia Dr, Suite 165, Jacksonville, NC 28546-6311 | 2011-10-18 |
| 1235417213 | Veronica Weaver | Counselor | 200 Valencia Dr, Suite 161, Jacksonville, NC 28546-6311 | 2011-07-25 |
| 1437451747 | Michelina H Therrien Lcsw Pa | Social Worker | 200 Valencia Dr, Suite 101, Jacksonville, NC 28546-6311 | 2010-11-19 |
| 1477863355 | Malachi Home Care,inc | Nursing Facility/Intermediate Care Facility | 200 Valencia Dr, Suite 103, Jacksonville, NC 28546-6311 | 2010-10-13 |
| 1518190511 | Suzan Douville | Counselor | 200 Valencia Dr, Suite 135, Jacksonville, NC 28546-6311 | 2009-08-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316578388 | Judylyn Hobson | Registered Nurse | Pride In North Carolina, LLC, 3886 Henderson Dr, Jacksonville, NC 28546 | 2020-01-29 |
| 1427694637 | Aaron Patrick Bettcher | Military Health Care Provider | 3rd Mrb Loop Rd, Camp Lejeune, NC 28546 | 2019-11-22 |
| 1962044289 | Levi Scott Marshall | Military Health Care Provider | Everett Creek Road, Building 612, Camp Lejeune, NC 28546 | 2019-10-09 |
| 1649826652 | Nicholas Otazo | Military Health Care Provider | 3rd Mrb 20073, Camp Lejeune, NC 28546 | 2019-08-15 |
| 1417519570 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 2001 Marlin Drive Unit 100, Jacksonville, NC 28546 | 2019-06-28 |
| 1023500212 | Josip Ninrodriguez | Military Health Care Provider | 3d Marine Raider Battaliom, Camp Lejeune, NC 28546 | 2018-06-04 |
| 1639661192 | Kenneth Lee Russell | Military Health Care Provider | 3d Marine Raider Battalion, Camp Lejeune, NC 28546 | 2018-05-31 |
| 1346730173 | Coastal Foot Center, LLC | Clinic/Center | 29 Office Park Dr Ste B, Jacksonville, NC 28546 | 2018-05-17 |
| 1578080271 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 380 Western Blvd, Jacksonville, NC 28546 | 2017-08-24 |
| 1144757493 | Darin Lee Peterson | Specialist/Technologist | G644 Camp Geiger, School of Infantry-east, Jacksonville, NC 28546 | 2017-05-17 |
| Find all providers in zip 28546 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447604806 | Rujvi Kamat | Clinical Neuropsychologist | 1235 San Marco Blvd Fl 4, Jacksonville, FL 32207-8554 | 2016-04-21 |
| 1750744405 | Andrew J Ruffett Phd LLC | Clinical Neuropsychologist | 11869 Curlew Way, Jacksonville, FL 32223-1939 | 2016-03-31 |
| 1629499819 | Bay Area Psychology Associates | Clinical Neuropsychologist | 302 Woodberry Pl, Jacksonville, NC 28540-4264 | 2013-12-14 |
| 1356778898 | Behavioral Health of North Florida Pllc | Clinical Neuropsychologist | 3733 University Blvd W Ste 214, Jacksonville, FL 32217-2128 | 2013-09-30 |
| 1093939498 | Christopher Rackley | Clinical Neuropsychologist | 1660 Prudential Dr Ste 210, Jacksonville, FL 32207-8185 | 2007-04-13 |
| 1336256353 | Elizabeth Tannahill Glen Keymer | Clinical Neuropsychologist | 751 Oak St Ste 120, Jacksonville, FL 32204-3359 | 2006-08-24 |
| 1215989991 | David S Sabsevitz | Clinical Neuropsychologist | 4500 San Pablo Rd S Dept Of, Jacksonville, FL 32224-1865 | 2006-05-17 |
| 1902880537 | Andrew J Ruffett | Clinical Neuropsychologist | 3617 Crown Point Rd, Ste 6, Jacksonville, FL 32257-9010 | 2005-12-06 |
| 1255331237 | Randi Most | Clinical Neuropsychologist | 13400 Sutton Park Dr S, Suite 1504, Jacksonville, FL 32224-0236 | 2005-07-30 |
| 1619973997 | Nicole Annette Hagedorn | Clinical Neuropsychologist | 2680 Henderson Dr Ste 5, Jacksonville, NC 28546-5297 | 2005-06-22 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 28546 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.