| Coastline Clinic Pllc | |
|
101b Villa Drive Suite 226 Daphne AL 36526 | |
| (251) 615-0000 | |
| Not Available |
| Full Name | Coastline Clinic Pllc |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 101b Villa Drive, Daphne, Alabama |
| Authorized Official Name and Position | Marcus Hamilton Lackey (FOUNDER) |
| Authorized Official Contact | 2516150000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastline Clinic Pllc 101b Villa Drive Suite 226 Daphne AL 36526 Ph: (251) 615-0000 | Coastline Clinic Pllc 101b Villa Drive Suite 226 Daphne AL 36526 Ph: (251) 615-0000 |
| NPI Number | 1942138839 |
|---|---|
| Provider Enumeration Date | 05/11/2026 |
| Last Update Date | 05/11/2026 |
| Certification Date | 05/06/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942138839 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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