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General NPI Number Information
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NPI Number | 1740089416
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Entity Type | Organization
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Legal Business Name | COASTAL PSYCHIATRY AND WELLNESS LLC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 10469 ATLEE STATION RD STE 100
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City | ASHLAND
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State | VA
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Zip | 23005-8913
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Country | US
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Telephone | 804-923-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 10469 ATLEE STATION RD STE 100
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City | ASHLAND
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State | VA
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Zip | 23005-8913
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Country | US
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Telephone | 804-932-4002
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Fax | 833-974-3888
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Authorized Official
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Title or Position | CEO AND PRACTICE MANAGER
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Name | TIMOTHY DERRICK SMITH
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Credential |
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Telephone | 804-923-4002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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