Provider Demographics
NPI:1467718122
Name:SCOTT, WILBERT O SR (RAS)
Entity Type:Individual
Prefix:
First Name:WILBERT
Middle Name:O
Last Name:SCOTT
Suffix:SR
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2852 CASHEW ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-7347
Mailing Address - Country:US
Mailing Address - Phone:510-381-0901
Mailing Address - Fax:
Practice Address - Street 1:1408 A ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2331
Practice Address - Country:US
Practice Address - Phone:925-978-2873
Practice Address - Fax:925-757-0411
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS1111101239101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS1111101239OtherBREINING