Organization
MIND SHINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SABRIYA LAILA SHARIF-HANIFA MS, LCASA (CEO)
(919) 758-4559
Entity
Organization
Contact information
Practice address
8360 SIX FORKS RD, RALEIGH, NC 27615-5077
(919) 758-4559
Mailing address
8360 SIX FORKS RD STE 102, RALEIGH, NC 27615-5087
(919) 758-4559
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
3175-A
NC
Other
Enumeration date
01/05/2018
Last updated
01/05/2018
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