Jessica Miranda Shine

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC014201 Issued in GA

Practice address

2967 Clarkston Rd
Augusta, GA 30909-9221

Phone

(470) 645-1541

Fax

(706) 685-1218

NPI assigned

Oct 25, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Healing and Healthy Counseling LLC

  • Mental Health Counselor
  • Augusta, GA
  • NPI 1811819998
  NPD (past) Authorized official

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1922725571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2967 CLARKSTON RD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309099221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2967 CLARKSTON RD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309099221",
            "telephone_number": "470-645-1541",
            "fax_number": "706-685-1218"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1343 Terrell Mill Rd SE Ste 228",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300679472",
            "country_code": "US",
            "telephone_number": "770-635-8505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHINE",
        "first_name": "JESSICA",
        "middle_name": "MIRANDA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-25",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "APC008605",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC014201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly C Shields
• James F. Shikle, M.D.
• Katie Shilling, RT(R)
• Dhanush Ramesh Shimoga, MBBS
• Danielle Shin
• William Bruce Shingleton, MD
• Chiara Shinholster, RN
• Brian Bates Shirley, NP
• Irina Shishkina, FNP-C
• Soumya Shivashankar, MD

• Professional Counselor in Augusta, GA
• Providers in Augusta, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; 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.