Organization
COASTAL MENTAL HEALTH & WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA DEFALCO CHARLAND (AMBR)
(941) 928-9774
Entity
Organization
Contact information
Practice address
11705 EVENING WALK DRIVE, LAKEWOOD RANCH, FL 34211
(941) 928-9774
Mailing address
PO BOX 728, NOKOMIS, FL 34274-0728
(941) 423-2728
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
09/29/2017
Last updated
01/09/2025
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