Provider Demographics
NPI:1265489363
Name:SCRUGGS, LYDIA PERRIN (LCSW)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:PERRIN
Last Name:SCRUGGS
Suffix:
Gender:F
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:PO BOX 2465
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-2465
Mailing Address - Country:US
Mailing Address - Phone:704-481-8626
Mailing Address - Fax:704-481-8507
Practice Address - Street 1:927 S LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-5851
Practice Address - Country:US
Practice Address - Phone:704-481-8626
Practice Address - Fax:704-481-8507
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0043801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD2624OtherINDIV. MEDCOST NUMBER
NC474794000OtherINDIV. MAGELLAN NUMBER
NC133R4OtherINDIV. BCBS NUMBER
NC6002598Medicaid
NC474794000OtherINDIV. MAGELLAN NUMBER
NC6002598Medicaid