Provider Demographics
NPI:1114075876
Name:SCROGGS, KENNETH ANDREW (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ANDREW
Last Name:SCROGGS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 MEDLOCK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3009
Mailing Address - Country:US
Mailing Address - Phone:770-448-1111
Mailing Address - Fax:770-449-8113
Practice Address - Street 1:3355 MEDLOCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3009
Practice Address - Country:US
Practice Address - Phone:770-448-1111
Practice Address - Fax:770-449-8113
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0006751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical