| Entity Name: | COASTAL PSYCHOLOGICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Apr 2020 (5 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 16 Nov 2024 (3 months ago) |
| Document Number: | L20000104312 |
| FEI/EIN Number | 85-2528199 |
| Address: | 3005 Lithia Pinecrest Rd, Valrico, FL, 33596, US |
| Mail Address: | 3987 14TH WAY NE, SAINT PETERSBURG, FL, 33703, US |
| ZIP code: | 33596 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487257853 | 2020-11-18 | 2020-11-18 | 3005 LITHIA PINECREST RD, VALRICO, FL, 335965630, US | 3005 LITHIA PINECREST RD, VALRICO, FL, 335965630, US | |||||||||||||||||||
|
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| Phone | +1 516-315-9771 |
Authorized person
| Name | AMANDA BAUER-MANZELLA |
| Role | OWNER |
| Phone | 5163159771 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | 1437752953 |
| Number | 1437752953 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Manzella Amanda | Agent | 3005 Lithia Pinecrest Rd, Valrico, FL, 33596 |
| Name | Role | Address |
|---|---|---|
| MANZELLA AMANDA | Authorized Person | 3987 14TH WAY NE, ST PETERSBURG, FL, 33703 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-11-16 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2024-11-16 | Manzella, Amanda | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-05-01 | 3005 Lithia Pinecrest Rd, Valrico, FL 33596 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-05-01 | 3005 Lithia Pinecrest Rd, Valrico, FL 33596 | No data |
| CHANGE OF MAILING ADDRESS | 2021-02-02 | 3005 Lithia Pinecrest Rd, Valrico, FL 33596 | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-11-16 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-04-04 |
| ANNUAL REPORT | 2021-02-02 |
| Florida Limited Liability | 2020-04-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
