Provider Demographics
NPI:1396490140
Name:HORTON, SHAWNETTE
Entity type:Individual
Prefix:
First Name:SHAWNETTE
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80 BOX 10754
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0010
Mailing Address - Country:US
Mailing Address - Phone:720-386-5736
Mailing Address - Fax:
Practice Address - Street 1:1355 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5143
Practice Address - Country:US
Practice Address - Phone:980-430-9205
Practice Address - Fax:704-799-8949
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NCA18290101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program