Provider Demographics
NPI:1275967127
Name:SCOTT, JESSIE M
Entity Type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:M
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 1:616 MARTIN LUTHER KING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4104
Mailing Address - Country:US
Mailing Address - Phone:843-355-6823
Mailing Address - Fax:
Practice Address - Street 1:616 MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4104
Practice Address - Country:US
Practice Address - Phone:843-355-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor