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
Phone: (904) 287-3122
Fax: (904) 287-3122
Website:
Health care specialties
| Specialty | Code | License # | 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 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1992821201 | NPPES |
| Florida | MEDICAID | 761636800 | |
| Florida | Other | SW0001447 |
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