Provider Demographics
NPI:1497057962
Name:HARGROVE-SCOTT, SHANNON (EDD,MSW,LCSW,LCASA)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:HARGROVE-SCOTT
Suffix:
Gender:F
Credentials:EDD,MSW,LCSW,LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 W WAYCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537-6933
Mailing Address - Country:US
Mailing Address - Phone:252-767-2246
Mailing Address - Fax:
Practice Address - Street 1:225 HORNER ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4128
Practice Address - Country:US
Practice Address - Phone:252-767-2246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-2569101YA0400X
NCC0080621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ43583AMedicare PIN