Healthcare Provider Details

I. General information

NPI: 1841106994
Provider Name (Legal Business Name): COASTAL MIND & WELLNESS GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 KINGS HWY STE 203
GALES FERRY CT
06335-1543
US

IV. Provider business mailing address

41 KINGS HWY STE 203
GALES FERRY CT
06335-1543
US

V. Phone/Fax

Practice location:
  • Phone: 860-389-4381
  • Fax:
Mailing address:
  • Phone: 860-389-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENEE LACADIE
Title or Position: APRN/OWNER
Credential: APRN
Phone: 860-389-4381