Provider Demographics
NPI:1922542950
Name:KALEIDOSCOPE COUNSELING
Entity Type:Organization
Organization Name:KALEIDOSCOPE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SHOREY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP/S
Authorized Official - Phone:864-485-2500
Mailing Address - Street 1:7280 REIDVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-9792
Mailing Address - Country:US
Mailing Address - Phone:864-485-2500
Mailing Address - Fax:
Practice Address - Street 1:2153 E MAIN ST
Practice Address - Street 2:C14 #385
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-8724
Practice Address - Country:US
Practice Address - Phone:864-590-1077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4594106H00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1141Medicaid