Provider Demographics
NPI:1790716009
Name:SCOTT, STACEY Y (LCP)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:Y
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 DEERFIELD CRES.
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2447
Mailing Address - Country:US
Mailing Address - Phone:757-956-6100
Mailing Address - Fax:757-956-6101
Practice Address - Street 1:105 WIST AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1701
Practice Address - Country:US
Practice Address - Phone:757-956-6100
Practice Address - Fax:757-956-6101
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003499103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014233C90Medicare PIN