Willie Shine, CSAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CSAC-20389 Issued in NC

Practice address

7925 North Tryon St
Charlotte, NC 28262

Phone

(704) 612-0566

Fax

(704) 498-4846

NPI assigned

Nov 24, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mr. Willie Shine Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416787200000",
    "number": "1407253123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7925 N TRYON ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282623408",
            "telephone_number": "980-612-0566",
            "fax_number": "704-498-4846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7925 NORTH TRYON ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28262",
            "telephone_number": "704-612-0566",
            "fax_number": "704-498-4846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHINE",
        "first_name": "WILLIE",
        "credential": "CSAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-11-24",
        "last_updated": "2014-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "CSAC-20389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WILLIE",
            "last_name": "SHINE",
            "prefix": "MR.",
            "credential": "CSAC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jihye Shin, NP
• Shine Adult Care LLC
• Shine Counseling, PLLC
• Shine Therapy LLC
• Stephanie Shine, CSAC
• Lakesha Shingler Howell, LCSW, LCAS
• Sharon Mercer Shinn
• Teisha Shiozaki, MD
• Travis Nathan Shipe, NP
• Ashley Nicole Shipley, MED

• Addiction (Substance Use Disorder) Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.