Shannon Wilson Otu, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C019066 Issued in NC

Practice address

809 Wickham Dr
Winterville, NC 28590-1610

Phone

(252) 902-4099

NPI assigned

Nov 11, 2022

Last updated

Sep 7, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788739200000",
    "number": "1447968052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 WICKHAM DR",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285901610",
            "telephone_number": "252-902-4099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 WICKHAM DR",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285901610",
            "telephone_number": "252-902-4099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTU",
        "first_name": "SHANNON",
        "middle_name": "WILSON",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-11",
        "last_updated": "2026-09-07",
        "certification_date": "2026-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C019066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Winterville, NC
• Providers in Winterville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.