Healthcare Provider Details

I. General information

NPI: 1710681606
Provider Name (Legal Business Name): SOULSHINE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 BRIGHT LEAF WAY
BALTIMORE MD
21209-3470
US

IV. Provider business mailing address

2308 BRIGHT LEAF WAY
BALTIMORE MD
21209-3470
US

V. Phone/Fax

Practice location:
  • Phone: 443-994-7243
  • Fax:
Mailing address:
  • Phone: 443-994-7243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JULIA GRACE KURISCH
Title or Position: OWNER
Credential: LCPC
Phone: 443-994-7243