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General NPI Number Information
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NPI Number | 1871022988
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Entity Type | Organization
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Legal Business Name | MIND SHINE, LLC
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8360 SIX FORKS RD STE 102
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City | RALEIGH
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State | NC
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Zip | 27615-5087
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Country | US
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Telephone | 919-758-4559
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Fax |
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Provider Business Mailing Address
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Address Line | 8360 SIX FORKS RD STE 102
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City | RALEIGH
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State | NC
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Zip | 27615-5087
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Country | US
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Telephone | 919-758-4559
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. SABRIYA LAILA SHARIF-HANIFA
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Credential | MS, LCASA
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Telephone | 919-758-4559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NC
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