Provider Demographics
NPI:1942547500
Name:SCOTT, MARY CALHOUN (M ED)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CALHOUN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WYANDOT ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-4214
Mailing Address - Country:US
Mailing Address - Phone:843-307-1339
Mailing Address - Fax:
Practice Address - Street 1:521 PARK ST
Practice Address - Street 2:
Practice Address - City:BISHOPVILLE
Practice Address - State:SC
Practice Address - Zip Code:29010-1133
Practice Address - Country:US
Practice Address - Phone:803-484-5337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3135103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool