Provider Demographics
NPI:1174578686
Name:SCOTT, JENNIFER JANET (ACSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JANET
Last Name:SCOTT
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 NORTH GROVE ST.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-4471
Mailing Address - Country:US
Mailing Address - Phone:828-696-9999
Mailing Address - Fax:828-696-2649
Practice Address - Street 1:512 NORTH GROVE ST.
Practice Address - Street 2:SUITE 103
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-4471
Practice Address - Country:US
Practice Address - Phone:828-696-9999
Practice Address - Fax:828-696-2649
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCCCSWC000413104100000X
NCC0004131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
143771OtherVALUE OPTIONS
NC6007231Medicaid
NC75029OtherBCBS
NC2861375Medicare PIN
NC75029OtherBCBS
NC6007231Medicaid