Provider Demographics
NPI:1669786109
Name:SHINSKE, CARRIE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:SHINSKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8512 VIA MALLORCA
Mailing Address - Street 2:UNIT C
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2504
Mailing Address - Country:US
Mailing Address - Phone:313-399-9167
Mailing Address - Fax:
Practice Address - Street 1:8512 VIA MALLORCA
Practice Address - Street 2:UNIT C
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-2504
Practice Address - Country:US
Practice Address - Phone:313-399-9167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health