Healthcare Provider Details

I. General information

NPI: 1124945779
Provider Name (Legal Business Name): SHEKINAH FAMILY COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK PLACE BLVD STE A2
KISSIMMEE FL
34741-2358
US

IV. Provider business mailing address

102 PARK PLACE BLVD STE A2
KISSIMMEE FL
34741-2358
US

V. Phone/Fax

Practice location:
  • Phone: 407-518-9505
  • Fax: 407-887-9529
Mailing address:
  • Phone: 407-518-9505
  • Fax: 407-887-9529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICIA LASALLE HENINGBURG
Title or Position: EXECUTIVE CLINICAL DIRECTOR
Credential: LMHC
Phone: 407-518-9505