Provider Demographics
NPI:1407984503
Name:WILLETT, SHAWNA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:
Last Name:WILLETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:
Other - Last Name:WILLETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CA
Mailing Address - Zip Code:95570-0674
Mailing Address - Country:US
Mailing Address - Phone:707-298-9800
Mailing Address - Fax:
Practice Address - Street 1:2440 6TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0788
Practice Address - Country:US
Practice Address - Phone:707-382-6822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA1112711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health