Provider Demographics
NPI:1437918539
Name:SCOTT, SHERDALE LATRICE (LMHP-R)
Entity Type:Individual
Prefix:
First Name:SHERDALE
Middle Name:LATRICE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 SPANISH GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CHASE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:23924-3906
Mailing Address - Country:US
Mailing Address - Phone:434-210-2016
Mailing Address - Fax:
Practice Address - Street 1:409 SPANISH GROVE RD
Practice Address - Street 2:
Practice Address - City:CHASE CITY
Practice Address - State:VA
Practice Address - Zip Code:23924-3906
Practice Address - Country:US
Practice Address - Phone:434-210-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health