Healthcare Provider Details

I. General information

NPI: 1134460132
Provider Name (Legal Business Name): COASTAL MEDICAL AND PSYCHIATRIC SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 DILIGENCE DR SUITE 206
NEWPORT NEWS VA
23606-4211
US

IV. Provider business mailing address

825 DILIGENCE DR SUITE 206
NEWPORT NEWS VA
23606-4211
US

V. Phone/Fax

Practice location:
  • Phone: 757-223-7098
  • Fax: 757-240-5936
Mailing address:
  • Phone: 757-223-7098
  • Fax: 757-240-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ADAMS
Title or Position: OWNER/MANAGER
Credential: NP
Phone: 757-223-7098