Healthcare Provider Details

I. General information

NPI: 1740089416
Provider Name (Legal Business Name): COASTAL PSYCHIATRY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10469 ATLEE STATION RD STE 100
ASHLAND VA
23005-8913
US

IV. Provider business mailing address

10469 ATLEE STATION RD STE 100
ASHLAND VA
23005-8913
US

V. Phone/Fax

Practice location:
  • Phone: 804-923-4002
  • Fax:
Mailing address:
  • Phone: 804-932-4002
  • Fax: 833-974-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY DERRICK SMITH
Title or Position: CEO AND PRACTICE MANAGER
Credential:
Phone: 804-923-4002