Individual
MR. DOUGLAS MARK SHINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
1705 DUCK WATER CT, SAINT JOHNS, FL 32259-5247
(904) 287-3122
(904) 287-3122
Mailing address
1705 DUCK WATER CT, JACKSONVILLE, FL 32259-5247
(904) 287-3122
(904) 287-3122
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW0001447
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
761636800
—
FL
01
—
SW0001447
CLINICAL SOCIAL WORKER FL
FL
Enumeration date
03/21/2007
Last updated
09/10/2012
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