Healthcare Provider Details

I. General information

NPI: 1336081033
Provider Name (Legal Business Name): COASTAL SOULS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 CRYSTAL GROVE BLVD
LUTZ FL
33548-6460
US

IV. Provider business mailing address

266 CRYSTAL GROVE BLVD
LUTZ FL
33548-6460
US

V. Phone/Fax

Practice location:
  • Phone: 813-575-0931
  • Fax:
Mailing address:
  • Phone: 813-575-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY DEL ROSARIO
Title or Position: OWNER
Credential: LMHC, CCTP
Phone: 813-575-0931