NPIMap

Organization Active NPI

Soul Shine Children'S Treatment Services, Inc.

  • Clinical Social Worker
  • Red Springs, NC
National Provider Identifier
1982818399
Registry record updated Jul 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C005175 Issued in NC
Legal business name
SOUL SHINE CHILDREN'S TREATMENT SERVICES, INC.
Practice address
218 E 2ND Ave
Red Springs, NC 28377-1308
Phone
(910) 536-6094
Fax
(910) 843-9728
NPI assigned
May 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2015

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

Authorized official

Name
Mrs. Leshia Rogers Deese, LCSW
Title
Owner
Phone
(910) 536-6094

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X LCAS-21969 NC
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X C005175 NC Primary

Addresses

Primary practice location

218 E 2ND Ave
Red Springs, NC 28377-1308

Mailing address

PO Box 1546
Pembroke, NC 28372-1546
Phone (910) 536-6094

Other identifiers 1

IdentifierTypeStateIssuer
6106174MedicaidNC

National Provider Directory

National Provider Directory

Locations

210 S Main St
Red Springs, NC 28377
Phone (910) 843-9727

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436400000000",
    "number": "1982818399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1546",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283721546",
            "telephone_number": "910-536-6094",
            "fax_number": "910-843-9728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 E 2ND AVE",
            "city": "RED SPRINGS",
            "state": "NC",
            "postal_code": "283771308",
            "telephone_number": "910-536-6094",
            "fax_number": "910-843-9728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL SHINE CHILDREN'S TREATMENT SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2015-07-09",
        "status": "A",
        "authorized_official_last_name": "DEESE",
        "authorized_official_first_name": "LESHIA",
        "authorized_official_middle_name": "ROGERS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-536-6094",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-21969",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C005175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6106174",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Springs, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.