Provider Demographics
NPI:1588107759
Name:COASTAL MEDICAL AND PSYCHIATRIC SERVICES, INC.
Entity type:Organization
Organization Name:COASTAL MEDICAL AND PSYCHIATRIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:757-310-6900
Mailing Address - Street 1:825 DILIGENCE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4272
Mailing Address - Country:US
Mailing Address - Phone:757-310-6900
Mailing Address - Fax:757-240-5936
Practice Address - Street 1:825 DILIGENCE DR STE 206
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4272
Practice Address - Country:US
Practice Address - Phone:757-310-6900
Practice Address - Fax:757-240-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174260261QM0855X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health