Provider Demographics
NPI:1740667195
Name:BARBER, SHUANTIA (LCSWA, MSW,LCAS)
Entity type:Individual
Prefix:
First Name:SHUANTIA
Middle Name:
Last Name:BARBER
Suffix:
Gender:F
Credentials:LCSWA, MSW,LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 MALLARD CREEK RD
Mailing Address - Street 2:STE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6001
Mailing Address - Country:US
Mailing Address - Phone:704-807-4366
Mailing Address - Fax:
Practice Address - Street 1:10130 MALLARD CREEK RD
Practice Address - Street 2:STE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6001
Practice Address - Country:US
Practice Address - Phone:704-807-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS21101174400000X, 101YA0400X
SC11518104100000X
NCC0114211041C0700X
NCP0101581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174400000XOther Service ProvidersSpecialist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)