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General NPI Number Information
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NPI Number | 1982818399
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Entity Type | Organization
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Legal Business Name | SOUL SHINE CHILDREN'S TREATMENT SERVICES, INC.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 218 E 2ND AVE
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City | RED SPRINGS
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State | NC
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Zip | 28377-1308
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Country | US
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Telephone | 910-536-6094
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Fax | 910-843-9728
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Provider Business Mailing Address
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Address Line | PO BOX 1546
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City | PEMBROKE
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State | NC
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Zip | 28372-1546
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Country | US
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Telephone | 910-536-6094
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Fax | 910-843-9728
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LESHIA ROGERS DEESE
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Credential | LCSW
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Telephone | 910-536-6094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-21969
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C005175
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License Number State | NC
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