Provider Demographics
NPI:1437548807
Name:SHORELINE COUNSELING LLC
Entity Type:Organization
Organization Name:SHORELINE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VON COLDITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-789-6850
Mailing Address - Street 1:10 PIER 1 STE 204
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-6328
Mailing Address - Country:US
Mailing Address - Phone:503-789-6850
Mailing Address - Fax:
Practice Address - Street 1:10 PIER 1 STE 204
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6328
Practice Address - Country:US
Practice Address - Phone:503-789-6850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL62921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty