Healthcare Provider Details

I. General information

NPI: 1679495220
Provider Name (Legal Business Name): SHAUNA LEE WILLOUGHBY MSW,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13211 HUNTING BIRDS LN
CHARLOTTE NC
28278-8785
US

IV. Provider business mailing address

13211 HUNTING BIRDS LN
CHARLOTTE NC
28278-8785
US

V. Phone/Fax

Practice location:
  • Phone: 704-470-2060
  • Fax: 704-533-4301
Mailing address:
  • Phone: 704-470-2060
  • Fax: 704-533-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: