Provider Demographics
NPI:1740089416
Name:COASTAL PSYCHIATRY AND WELLNESS LLC
Entity type:Organization
Organization Name:COASTAL PSYCHIATRY AND WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DERRICK
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-923-4002
Mailing Address - Street 1:15050 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-2955
Mailing Address - Country:US
Mailing Address - Phone:804-370-1869
Mailing Address - Fax:
Practice Address - Street 1:10469 ATLEE STATION RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-8913
Practice Address - Country:US
Practice Address - Phone:804-923-4002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty