Shannon C Fahy, MSW LCSW LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C013648 Issued in NC

Practice address

637 Barneswyck Dr
Fuquay Varina, NC 27526-2277

Phone

(919) 839-9721

Fax

(919) 440-4760

NPI assigned

Apr 29, 2009

Reactivated

Sep 26, 2024

Last updated

Sep 17, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Modern Mystics, LLC

  • Clinical Social Worker
  • Fuquay Varina, NC
  • NPI 1942060215
  NPD Authorized official
• Trumbull Mahoning Medical Group, Inc.

  • Internal Medicine Physician
  • Youngstown, OH
  • NPI 1538353883
  NPD (past)

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

{
    "created_epoch": "1240963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758067200000",
    "number": "1801030168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 BARNESWYCK DR",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275262277",
            "telephone_number": "919-839-9721",
            "fax_number": "984-444-4760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "637 BARNESWYCK DR",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275262277",
            "telephone_number": "919-839-9721",
            "fax_number": "919-440-4760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4025 Rawlins St",
            "address_purpose": "LOCATION",
            "city": "Cheyenne",
            "state": "WY",
            "postal_code": "820011900",
            "country_code": "US",
            "telephone_number": "307-426-4798",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAHY",
        "first_name": "SHANNON",
        "middle_name": "C",
        "credential": "MSW LCSW LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-29",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "deactivation_date": "2024-09-11",
        "reactivation_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WY",
            "license": "696",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61613757",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C013648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "453732",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801030168",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Uchenna Harrison Enyinnaya, NP
• Catherine Ann Estes, LCSW
• Evans Walston Home LLC (Evans Walston Home)
• Every Season Counseling PLLC
• Evolve Physical Therapy LLC
• Family Optical LLC
• Tiffany Eve Fass
• Samantha May Faust, BSN, RN, IBCLC
• Elisabeth Feeley, MS CCC-SLP
• Shanda Nicole Felton, PA

• Clinical Social Worker in Fuquay Varina, NC
• Providers in Fuquay Varina, 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 17, 2025; 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.