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General NPI Number Information
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NPI Number | 1952822587
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Entity Type | Organization
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Legal Business Name | SHINE WELLNESS CLINIC, PLLC
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 1 N STARKWEATHER ALY FL 3
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City | ROMEO
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State | MI
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Zip | 48065-4690
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Country | US
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Telephone | 586-281-6815
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Fax |
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Provider Business Mailing Address
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Address Line | 1 N STARKWEATHER ALY FL 3
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City | ROMEO
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State | MI
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Zip | 48065-4690
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NAOMI MARGARET BABA
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Credential | LMSW
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Telephone | 810-531-5333
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801091649
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License Number State | MI
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