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General NPI Number Information
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NPI Number | 1689537656
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Entity Type | Individual
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Provider Name | SHAWNETTA GANTT-WILKINS LPC-S, LCDC, ASOTP,
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Gender | Female
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Dates
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Enumeration Date | 12/06/2025
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 2021 GUADALUPE ST STE 260
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City | AUSTIN
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State | TX
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Zip | 78705-5654
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Country | US
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Telephone | 646-941-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 506 WHITNEY ST
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City | CEDAR HILL
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State | TX
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Zip | 75104-2898
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Country | US
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Telephone | 646-453-6777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10345
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 61697
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License Number State | TX
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