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General NPI Number Information
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NPI Number | 1386004745
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Entity Type | Organization
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Legal Business Name | J&J SHINE CORP
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8051 N. TAMIAMI TRAIL SUITE E2, BOX 37
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City | SARASOTA
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State | FL
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Zip | 34243
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Country | US
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Telephone | 941-822-8174
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Fax | 941-822-8174
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Provider Business Mailing Address
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Address Line | 8051 N. TAMIAMI TRAIL SUITE E2, BOX 37
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City | SARASOTA
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State | FL
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Zip | 34243
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Country | US
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Telephone | 941-822-8174
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Fax | 941-822-8174
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANELL STALLWORTH
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Credential | LMHC
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Telephone | 941-822-8174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH12905
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License Number State | FL
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