Individual
DR. JESSICA MIRANDA SHINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2967 CLARKSTON RD, AUGUSTA, GA 30909-9221
(470) 645-1541
(706) 685-1218
Mailing address
2967 CLARKSTON RD, AUGUSTA, GA 30909-9221
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
APC008605
GA
101YP2500X
Professional Counselor
Primary
LPC014201
GA
Other
Enumeration date
10/25/2022
Last updated
10/11/2023
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