Willie Shine CSAC

NPI 1407253123 - Counselor - 101YA0400X

NPI Details
NPI 1407253123
Gender Male
Enumeration Date 11/24/2014
Last Updated 11/24/2014
Entity Type Individual
Active Over 2 years ago
Practice Location
7925 NORTH TRYON ST
CHARLOTTE NC, 28262, US
Phone (704) 612-0566
Fax (704) 498-4846
Business Location
7925 N TRYON ST
CHARLOTTE NC, 28262-3408, US
Phone (980) 612-0566
Fax (704) 498-4846
Toxanomy
Taxonomy Code 101YA0400X
License State North Carolina
License Number CSAC-20389
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According to our database, Willie Shine CSAC NPI is 1407253123, taxonomy code is 101YA0400X and license number is CSAC-20389, license state is located at North Carolina. Willie Shine CSAC physically located at 7925 North Tryon St, Charlotte NC, 28262. NPI Number Willie Shine CSAC has the Individual type.

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1407253123 NPI number is provided on an as is basis without warranty of any kind. 1407253123 is maintained by the National Plan & Provider Enumeration System. The contents of Willie Shine CSAC are for informational purposes only.