Provider Demographics
NPI:1619126521
Name:ROSE, SCOTT CURTIS (CASAC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CURTIS
Last Name:ROSE
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-6131
Mailing Address - Country:US
Mailing Address - Phone:704-680-3134
Mailing Address - Fax:
Practice Address - Street 1:937 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-6131
Practice Address - Country:US
Practice Address - Phone:704-680-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17323101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)