Healthcare Provider Details

I. General information

NPI: 1104527332
Provider Name (Legal Business Name): COASTAL VIRGINIA MENTAL HEALTH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 DIAMOND SPRINGS RD STE 401
VIRGINIA BEACH VA
23455-3632
US

IV. Provider business mailing address

1300 DIAMOND SPRINGS RD STE 401
VIRGINIA BEACH VA
23455-3632
US

V. Phone/Fax

Practice location:
  • Phone: 757-724-0980
  • Fax:
Mailing address:
  • Phone: 757-724-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. SOPHIA C SILLS-TAILOR
Title or Position: OWNER
Credential: LPC
Phone: 757-724-0980