Provider Demographics
NPI:1770274250
Name:SHADOWENS, WHITNEY (LCSW)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:SHADOWENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11922 VALENCIA CT
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-3438
Mailing Address - Country:US
Mailing Address - Phone:727-692-0452
Mailing Address - Fax:
Practice Address - Street 1:3023 ALT 19 STE 102
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1930
Practice Address - Country:US
Practice Address - Phone:727-220-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW214171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical