Provider Demographics
NPI:1275766271
Name:STOTT, MATTIE WEEMS (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MATTIE
Middle Name:WEEMS
Last Name:STOTT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 RIVERBOAT CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5438
Mailing Address - Country:US
Mailing Address - Phone:410-610-0416
Mailing Address - Fax:
Practice Address - Street 1:1119 RIVERBOAT CT
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-5438
Practice Address - Country:US
Practice Address - Phone:410-610-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD589561803Medicaid