Provider Demographics
NPI:1053923185
Name:SCOTT, ANNIE J (LPC)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 CROSSWAYS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0205
Mailing Address - Country:US
Mailing Address - Phone:757-309-1405
Mailing Address - Fax:757-514-8642
Practice Address - Street 1:1545 CROSSWAYS BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0205
Practice Address - Country:US
Practice Address - Phone:757-309-1405
Practice Address - Fax:757-514-8642
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty