Provider Demographics
NPI:1598061822
Name:SCOTT, SHAMIKA GLENETTA (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHAMIKA
Middle Name:GLENETTA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 211041
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29221
Mailing Address - Country:US
Mailing Address - Phone:803-665-8532
Mailing Address - Fax:
Practice Address - Street 1:7725 ST. ANDREWS RD.
Practice Address - Street 2:SUITE 4
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063
Practice Address - Country:US
Practice Address - Phone:803-665-8532
Practice Address - Fax:803-749-3290
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional