Provider Demographics
NPI:1447407994
Name:SCOTT-DARDEN, ALICIA OCTAVIA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:OCTAVIA
Last Name:SCOTT-DARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:OCTAVIA
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7447 CATTERICK CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-5600
Mailing Address - Country:US
Mailing Address - Phone:443-756-6599
Mailing Address - Fax:
Practice Address - Street 1:7447 CATTERICK CT
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-5600
Practice Address - Country:US
Practice Address - Phone:443-756-6599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR124214363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health