Provider Demographics
NPI:1598514820
Name:CORAL COVE COUNSELING LLC
Entity type:Organization
Organization Name:CORAL COVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPC
Authorized Official - Phone:757-524-1318
Mailing Address - Street 1:1321 WOODBRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-1656
Mailing Address - Country:US
Mailing Address - Phone:609-440-7735
Mailing Address - Fax:
Practice Address - Street 1:249 CENTRAL PARK AVE STE 300
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3271
Practice Address - Country:US
Practice Address - Phone:757-524-1318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty