Provider Demographics
NPI:1972929396
Name:SHORELINE COUNSELING, LLC
Entity type:Organization
Organization Name:SHORELINE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:401-226-7407
Mailing Address - Street 1:701 WILCOX ROAD
Mailing Address - Street 2:SUITE 107F
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378
Mailing Address - Country:US
Mailing Address - Phone:401-226-7407
Mailing Address - Fax:
Practice Address - Street 1:701 WILCOX ROAD SUITE 107F
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06378-2614
Practice Address - Country:US
Practice Address - Phone:401-226-7407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty