Healthcare Provider Details

I. General information

NPI: 1548994718
Provider Name (Legal Business Name): ROSHAWNDA WOOTEN-WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S. MCDOWELL STREET SUITE 125
CHARLOTTE NC
28204
US

IV. Provider business mailing address

300 S. MCDOWELL STREET SUITE 125
CHARLOTTE NC
28204
US

V. Phone/Fax

Practice location:
  • Phone: 980-349-6047
  • Fax:
Mailing address:
  • Phone: 980-349-6047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018385
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: