Provider Demographics
NPI:1023796570
Name:SCOTT, KIA LASHAWN
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:LASHAWN
Last Name:SCOTT
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 1:309 LISMORE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-3909
Mailing Address - Country:US
Mailing Address - Phone:267-808-7985
Mailing Address - Fax:
Practice Address - Street 1:309 LISMORE AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-3909
Practice Address - Country:US
Practice Address - Phone:267-808-7985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional