Provider Demographics
NPI:1063934875
Name:SUNSHINE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:SUNSHINE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-796-1832
Mailing Address - Street 1:1809 E BROADWAY ST STE 147
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8597
Mailing Address - Country:US
Mailing Address - Phone:407-432-8530
Mailing Address - Fax:
Practice Address - Street 1:2040 WINTER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9347
Practice Address - Country:US
Practice Address - Phone:407-796-1832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021575000Medicaid