Basic Information
| Provider Information | |||||||||
| NPI: | 1205902020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST COAST SOLUTIONS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1314 S 16TH ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284016422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102518930 | ||||||||
| FaxNumber: | 9102518933 | ||||||||
| Practice Location | |||||||||
| Address1: | 1390 S 16TH ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284016422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102515326 | ||||||||
| FaxNumber: | 9102515324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 06/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | ALBERS | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9102518930 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MSW, LCSW, LCAS, CCS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | MHL 065-185 | NC | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 5904961 | 05 | NC | MEDICAID | 8301568 | 05 | NC | MEDICAID | 6005924 | 05 | NC | MEDICAID |