Provider Demographics
NPI:1033631783
Name:SOULSHINE COUNSELING, L.C.S.W., P.C.
Entity Type:Organization
Organization Name:SOULSHINE COUNSELING, L.C.S.W., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VON BAEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:845-913-6562
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:VAILS GATE
Mailing Address - State:NY
Mailing Address - Zip Code:12584-0171
Mailing Address - Country:US
Mailing Address - Phone:845-913-6562
Mailing Address - Fax:845-522-8817
Practice Address - Street 1:871 BLOOMING GROVE TPKE
Practice Address - Street 2:
Practice Address - City:VAILS GATE
Practice Address - State:NY
Practice Address - Zip Code:12584
Practice Address - Country:US
Practice Address - Phone:845-913-6562
Practice Address - Fax:845-522-8817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0789131251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health