# COASTAL TRANQUILITY BEHAVIORAL HEALTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205609807
- **Authorized official:** JENNIFER BAINUM (OWNER)
- **Authorized official phone:** (619) 417-0654

## Contact information

- **Practice address:** 925 OLD HOMESTEAD LN, VIRGINIA BEACH, VA 23464-4013
- **Practice address phone:** (757) 752-8682
- **Practice address fax:** (757) 432-3269
- **Mailing address:** 110 COLISEUM XING \# 5353, HAMPTON, VA 23666-5971
- **Mailing address phone:** (757) 752-8682
- **Mailing address fax:** (757) 432-3269

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/06/2023
- **Last updated:** 09/03/2024