Provider Demographics
NPI:1104527332
Name:COASTAL VIRGINIA MENTAL HEALTH SERVICES PLLC
Entity type:Organization
Organization Name:COASTAL VIRGINIA MENTAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SILLS-TAILOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-724-0980
Mailing Address - Street 1:1300 DIAMOND SPRINGS RD STE 401
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-3632
Mailing Address - Country:US
Mailing Address - Phone:757-724-0980
Mailing Address - Fax:
Practice Address - Street 1:1300 DIAMOND SPRINGS RD STE 401
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-3632
Practice Address - Country:US
Practice Address - Phone:757-724-0980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty