| Coastal Mental Health & Wellness, Llc | |
|
11705 Evening Walk Drive Lakewood Ranch FL 34211 | |
| (941) 928-9774 | |
| Not Available |
| Full Name | Coastal Mental Health & Wellness, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 11705 Evening Walk Drive, Lakewood Ranch, Florida |
| Authorized Official Name and Position | Victoria Defalco Charland (AMBR) |
| Authorized Official Contact | 9419289774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Mental Health & Wellness, Llc 1767 Lakewood Ranch Blvd # 315 Bradenton FL 34211-4906 Ph: (941) 423-2728 | Coastal Mental Health & Wellness, Llc 11705 Evening Walk Drive Lakewood Ranch FL 34211 Ph: (941) 928-9774 |
| NPI Number | 1679082978 |
|---|---|
| Provider Enumeration Date | 09/29/2017 |
| Last Update Date | 02/23/2023 |
| Certification Date | 02/15/2023 |
| Medicare PECOS PAC ID | 3971862665 |
|---|---|
| Medicare Enrollment ID | O20180126000678 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679082978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kristin L Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942565155 PECOS PAC ID: 7113173063 Enrollment ID: I20120808000341 |
| Provider Name | Cheryl R. Lamb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306254073 PECOS PAC ID: 1254551039 Enrollment ID: I20140929001854 |
| Provider Name | Victoria Charland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487062626 PECOS PAC ID: 6406076207 Enrollment ID: I20140930000046 |
| Provider Name | Tanya R Hendry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417316845 PECOS PAC ID: 9335448893 Enrollment ID: I20160504002098 |
| Provider Name | Danielle Kathleen West |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295329738 PECOS PAC ID: 5092121368 Enrollment ID: I20210311000201 |
| Provider Name | Melissa Sevigny |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497338230 PECOS PAC ID: 9830591544 Enrollment ID: I20210716001279 |
| Provider Name | Jennifer D Kennedy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497402390 PECOS PAC ID: 1355737487 Enrollment ID: I20220329002680 |
| Provider Name | Kelly Marie Lehman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366462145 PECOS PAC ID: 2163875170 Enrollment ID: I20240125004037 |
| Provider Name | Rachel Marie Westphal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629846316 PECOS PAC ID: 3678913852 Enrollment ID: I20240506000338 |
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