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: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 E GARRISON BLVD
GASTONIA NC
28054-5143
US

IV. Provider business mailing address

PSC 80 BOX 10754
APO AP
96367-0010
US

V. Phone/Fax

Practice location:
  • Phone: 980-430-9205
  • Fax: 704-799-8949
Mailing address:
  • Phone: 720-386-5736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA18290
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: