| Coastal Christian Counseling | |
|
112 Buena Vista Dr Long Beach MS 39560-5703 | |
| (681) 242-7651 | |
| Not Available |
| Full Name | Coastal Christian Counseling |
|---|---|
| Speciality | Social Worker |
| Location | 112 Buena Vista Dr, Long Beach, Mississippi |
| Authorized Official Name and Position | Marlena Janette Pique (OWNER/THERAPIST) |
| Authorized Official Contact | 6812427651 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Christian Counseling 37 Vane Dr Martinsburg WV 25403-0200 Ph: (681) 242-7651 | Coastal Christian Counseling 112 Buena Vista Dr Long Beach MS 39560-5703 Ph: (681) 242-7651 |
| NPI Number | 1861162042 |
|---|---|
| Provider Enumeration Date | 09/17/2021 |
| Last Update Date | 09/17/2021 |
| Certification Date | 09/17/2021 |
| Medicare PECOS PAC ID | 7012308984 |
|---|---|
| Medicare Enrollment ID | O20220104000122 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861162042 | NPI | - | NPPES |
| C9986 | Other | MS | CLINICAL SOCIAL WORK LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Keith A Dangelo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174856835 PECOS PAC ID: 3577696400 Enrollment ID: I20100729000392 |
| Provider Name | Marlena Pique |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942569181 PECOS PAC ID: 7719141555 Enrollment ID: I20220105000076 |
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