| Soul Shine Children's Treatment Services, Inc. | |
|
218 E 2nd Ave Red Springs NC 28377-1308 | |
| (910) 536-6094 | |
| (910) 843-9728 |
| Full Name | Soul Shine Children's Treatment Services, Inc. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 218 E 2nd Ave, Red Springs, North Carolina |
| Authorized Official Name and Position | Leshia Rogers Deese (OWNER) |
| Authorized Official Contact | 9105366094 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Soul Shine Children's Treatment Services, Inc. Po Box 1546 Pembroke NC 28372-1546 Ph: (910) 536-6094 | Soul Shine Children's Treatment Services, Inc. 218 E 2nd Ave Red Springs NC 28377-1308 Ph: (910) 536-6094 |
| NPI Number | 1982818399 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 07/09/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982818399 | NPI | - | NPPES |
| 6106174 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LCAS-21969 (North Carolina) | Secondary |
| 1041C0700X | Social Worker - Clinical | C005175 (North Carolina) | Primary |
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