NPIMap

Organization Active NPI

Shine Counseling, PLLC

  • Community/Behavioral Health Agency
  • Charlotte, NC
National Provider Identifier
1871066019
Registry record updated Aug 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
SHINE COUNSELING, PLLC
Practice address
1931 J N Pease PL Ste 104
Charlotte, NC 28262-4540
Phone
(704) 734-9480
Fax
(844) 786-5796
NPI assigned
Jan 10, 2019
Last updated
Aug 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Parker, LCSWNPI 1922502061
Title
Owner
Phone
(704) 548-1328

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

1931 J N Pease PL Ste 104
Charlotte, NC 28262-4540

Mailing address

1931 J N Pease PL Ste 104
Charlotte, NC 28262-4540
Phone (704) 548-1328

Other identifiers 1

IdentifierTypeStateIssuer
1041C0700XMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191030003707 NC Part B Supplier - Clinic/Group Practice 5799017349 Receives reassigned benefits from 4 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692489600000",
    "number": "1871066019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1931 J N PEASE PL STE 104",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624540",
            "telephone_number": "704-548-1328",
            "fax_number": "844-786-5896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1931 J N PEASE PL STE 104",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624540",
            "telephone_number": "704-734-9480",
            "fax_number": "844-786-5796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-10",
        "last_updated": "2023-08-20",
        "certification_date": "2023-08-20",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-548-1328",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1041C0700X",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.