Healthcare Provider Details

I. General information

NPI: 1902741713
Provider Name (Legal Business Name): COASTAL COUNSELING OF NORTH FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 MARSH LANDING BLVD STE 104&203
PONTE VEDRA FL
32082-7215
US

IV. Provider business mailing address

3948 3RD ST S # 351
JACKSONVILLE BEACH FL
32250-5847
US

V. Phone/Fax

Practice location:
  • Phone: 904-373-1837
  • Fax: 904-604-8700
Mailing address:
  • Phone: 904-373-1837
  • Fax: 904-604-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PAULA BAUER
Title or Position: OWNER
Credential: LCSW
Phone: 904-373-1837