Provider Demographics
NPI:1124006937
Name:SCOTT, JEAN DIANNE (LCSW, RN)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:DIANNE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 HORSESHOE ROAD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-8507
Mailing Address - Country:US
Mailing Address - Phone:252-335-2018
Mailing Address - Fax:252-335-9521
Practice Address - Street 1:1129 HORSESHOE ROAD
Practice Address - Street 2:ALBEMARLE COUNSELING GROUP
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-8507
Practice Address - Country:US
Practice Address - Phone:252-335-2018
Practice Address - Fax:252-335-9521
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0004141041C0700X
NC060005163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002188Medicaid
P31708Medicare UPIN
2861595Medicare PIN