Provider Demographics
NPI:1083128409
Name:SCOTT, VALARIA SHANTE (CART)
Entity Type:Individual
Prefix:
First Name:VALARIA
Middle Name:SHANTE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-1707
Mailing Address - Country:US
Mailing Address - Phone:678-900-1255
Mailing Address - Fax:
Practice Address - Street 1:112 W ATHENS ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-1707
Practice Address - Country:US
Practice Address - Phone:678-900-1255
Practice Address - Fax:678-900-1255
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA252458232101YP2500X, 101YA0400X
GA4621534450679808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)