Provider Demographics
NPI:1417364647
Name:COASTAL BEHAVIOR CONSULTING, LLC
Entity Type:Organization
Organization Name:COASTAL BEHAVIOR CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRIFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA, LBA
Authorized Official - Phone:757-962-9110
Mailing Address - Street 1:1030 JAMESTOWN CRES
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1260
Mailing Address - Country:US
Mailing Address - Phone:757-962-9110
Mailing Address - Fax:
Practice Address - Street 1:1030 JAMESTOWN CRES
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-1260
Practice Address - Country:US
Practice Address - Phone:757-962-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000134103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1356577886OtherINDIVIDUAL NPI