Provider Demographics
NPI:1902212723
Name:SHOTWELL, CARTER LEE (LCSW-A)
Entity Type:Individual
Prefix:MR
First Name:CARTER
Middle Name:LEE
Last Name:SHOTWELL
Suffix:
Gender:M
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 COLTRANE MILL RD
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-8020
Mailing Address - Country:US
Mailing Address - Phone:336-674-6293
Mailing Address - Fax:
Practice Address - Street 1:1324 COLTRANE MILL RD
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317-8020
Practice Address - Country:US
Practice Address - Phone:336-674-6293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0090301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302093Medicaid