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General NPI Number Information
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NPI Number | 1659011237
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Entity Type | Organization
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Legal Business Name | COASTAL CENTER FOR CONNECTION
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Dates
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Enumeration Date | 03/31/2022
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 317 OFFICE SQUARE LN STE B101
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3652
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Country | US
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Telephone | 757-403-4953
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Fax |
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Provider Business Mailing Address
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Address Line | 9518 3RD BAY ST UNIT 120
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City | NORFOLK
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State | VA
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Zip | 23518-1013
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Country | US
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Telephone | 760-421-8455
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRACI WHITLEY
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Credential | LMFT
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Telephone | 760-421-8455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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