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General NPI Number Information
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NPI Number | 1205609807
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Entity Type | Organization
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Legal Business Name | COASTAL TRANQUILITY BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 925 OLD HOMESTEAD LN
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4013
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Country | US
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Telephone | 757-752-8682
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Fax | 757-432-3269
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Provider Business Mailing Address
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Address Line | 110 COLISEUM XING # 5353
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City | HAMPTON
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State | VA
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Zip | 23666-5971
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Country | US
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Telephone | 757-752-8682
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Fax | 757-432-3269
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER BAINUM
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Credential |
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Telephone | 619-417-0654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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