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1528625738
SHANE MICHAEL SHORT
SANTA ROSA, CA
NPI
1528625738
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2019-05-22
Last Update Date
2019-05-22
Business Address
SHANE MICHAEL SHORT
2403 PROFESSIONAL DR
SANTA ROSA, CA 95403-3007
Phone number: 707-544-3295
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Mailing Address
SHANE MICHAEL SHORT
2403 PROFESSIONAL DR
SANTA ROSA, CA 95403-3007
Phone number: 707-544-3295
Copy
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