Provider Demographics
NPI:1548994718
Name:WOOTEN-WHITE, ROSHAWNDA
Entity type:Individual
Prefix:
First Name:ROSHAWNDA
Middle Name:
Last Name:WOOTEN-WHITE
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 1:5909 COUGAR LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1522
Mailing Address - Country:US
Mailing Address - Phone:907-687-3986
Mailing Address - Fax:
Practice Address - Street 1:7752 GATEWAY LN NW STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4421
Practice Address - Country:US
Practice Address - Phone:704-896-7776
Practice Address - Fax:704-896-0992
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0159671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical