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Organization
COASTAL PSYCHOLOGICAL GROUP, LLC
Active
Organization
COASTAL PSYCHOLOGICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA BAUER-MANZELLA LMHC (OWNER)
(516) 315-9771
Entity
Organization
Contact information
Practice address
3005 LITHIA PINECREST RD, VALRICO, FL 33596-5630
(516) 315-9771
Mailing address
3005 LITHIA PINECREST RD, VALRICO, FL 33596-5630
(516) 315-9771
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437752953
1437752953
FL
Enumeration date
11/18/2020
Last updated
11/18/2020
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