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General NPI Number Information
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NPI Number | 1598514820
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Entity Type | Organization
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Legal Business Name | CORAL COVE COUNSELING LLC
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Dates
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Enumeration Date | 05/17/2024
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 249 CENTRAL PARK AVE STE 300
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3271
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Country | US
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Telephone | 757-524-1318
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Fax |
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Provider Business Mailing Address
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Address Line | 1321 WOODBRIDGE TRL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23453-1656
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Country | US
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Telephone | 609-440-7735
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAUREEN ELIZABETH KELLY
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Credential | PSY.D., LPC
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Telephone | 757-524-1318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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