Healthcare Provider Details

I. General information

NPI: 1124908397
Provider Name (Legal Business Name): SHORELINE COUNSELING & HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2025
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7918 JONES BRANCH DR # 439
MC LEAN VA
22102-3337
US

IV. Provider business mailing address

7918 JONES BRANCH DR # 439
MC LEAN VA
22102-3337
US

V. Phone/Fax

Practice location:
  • Phone: 757-769-4417
  • Fax:
Mailing address:
  • Phone: 757-769-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JUSTINE SIME
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 757-769-4417