Individual
WILLIE SHINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSAC
Contact information
Practice address
7925 NORTH TRYON ST, CHARLOTTE, NC 28262
(704) 612-0566
(704) 498-4846
Mailing address
7925 N TRYON ST, CHARLOTTE, NC 28262-3408
(980) 612-0566
(704) 498-4846
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSAC-20389
NC
Other
Enumeration date
11/24/2014
Last updated
11/24/2014
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