Healthcare Provider Details

I. General information

NPI: 1396490140
Provider Name (Legal Business Name): SHAWNETTE HORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5970 FAIRVIEW RD STE 600
CHARLOTTE NC
28210-2111
US

IV. Provider business mailing address

950 LUCAS ST
ROCK HILL SC
29730-4186
US

V. Phone/Fax

Practice location:
  • Phone: 704-885-6435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10781
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18290
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: