Provider Demographics
NPI:1134460132
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:OWNER/MANAGER
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:757-223-7098
Mailing Address - Street 1:825 DILIGENCE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4211
Mailing Address - Country:US
Mailing Address - Phone:757-223-7098
Mailing Address - Fax:757-240-5936
Practice Address - Street 1:825 DILIGENCE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4211
Practice Address - Country:US
Practice Address - Phone:757-223-7098
Practice Address - Fax:757-240-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134460132Medicaid
VA1134460132Medicaid