Shine, Douglas Mark

Shine, Douglas Mark is an sole proprietor health care provider with primary practice located at 1705 Duck Water Ct , Saint Johns FL 32259-5247. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Shine, Douglas Mark can be contacted via phone (904) 287-3122.

Contact Information

Primary practice address
1705 Duck Water Ct Saint Johns FL 32259-5247
Fax: (904) 287-3122
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X SW0001447 Florida

Profile Details

NPI number 1992821201
LBN Legal business name Shine, Douglas Mark
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 21st, 2007
Last updated Sep 10th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992821201 NPPES
Florida MEDICAID 761636800
Florida Other SW0001447

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