Provider Demographics
NPI:1710532536
Name:SCALES, BREAUDREA
Entity Type:Individual
Prefix:
First Name:BREAUDREA
Middle Name:
Last Name:SCALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24148-1554
Mailing Address - Country:US
Mailing Address - Phone:276-340-8965
Mailing Address - Fax:
Practice Address - Street 1:19 WICKERSHAM ROAD
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:VA
Practice Address - Zip Code:24148
Practice Address - Country:US
Practice Address - Phone:276-340-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator