Provider Demographics
NPI:1164646386
Name:SERAFY, SCOTT PENDLETON (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:PENDLETON
Last Name:SERAFY
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1738
Mailing Address - Country:US
Mailing Address - Phone:478-745-8301
Mailing Address - Fax:
Practice Address - Street 1:144 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2860
Practice Address - Country:US
Practice Address - Phone:478-475-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA288797722BMedicaid