Provider Demographics
NPI:1114426426
Name:SCOTT, DOMINICA
Entity Type:Individual
Prefix:
First Name:DOMINICA
Middle Name:
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 1:31990B LACROIX RD
Mailing Address - Street 2:
Mailing Address - City:WHITE CASTLE
Mailing Address - State:LA
Mailing Address - Zip Code:70788-3621
Mailing Address - Country:US
Mailing Address - Phone:225-716-2478
Mailing Address - Fax:
Practice Address - Street 1:31990B LACROIX RD
Practice Address - Street 2:
Practice Address - City:WHITE CASTLE
Practice Address - State:LA
Practice Address - Zip Code:70788-3621
Practice Address - Country:US
Practice Address - Phone:225-716-2478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health