Healthcare Provider Details

I. General information

NPI: 1740107770
Provider Name (Legal Business Name): COE PSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 PASEO REYES DR
ST AUGUSTINE FL
32095-8558
US

IV. Provider business mailing address

158 CUMBERLAND ISLAND CIR
PONTE VEDRA FL
32081-0721
US

V. Phone/Fax

Practice location:
  • Phone: 919-699-2077
  • Fax:
Mailing address:
  • Phone: 919-699-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CARA O'CONNELL-EDWARDS
Title or Position: SOLE MEMBER
Credential: PH.D.
Phone: 919-699-2077