Healthcare Provider Details

I. General information

NPI: 1326952524
Provider Name (Legal Business Name): SHINE (SUPPORTING HEALTH IN NAVIGATING EMOTIONS)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E MAIN ST STE 202
ABINGDON VA
24210-2903
US

IV. Provider business mailing address

2050 LEE HWY
BRISTOL VA
24201-1626
US

V. Phone/Fax

Practice location:
  • Phone: 276-207-8577
  • Fax:
Mailing address:
  • Phone: 276-207-8577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LOGAN LOVE
Title or Position: MARRIAGE AND FAMILY THERAPIST (LIC)
Credential: LMFT
Phone: 276-791-1712