Provider Demographics
NPI:1942812789
Name:SCOTT, CARSON LEIGH (MED, LPC)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:LEIGH
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:CARSON
Other - Middle Name:
Other - Last Name:MCLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1304 MCKINNEY AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-1626
Mailing Address - Country:US
Mailing Address - Phone:434-661-8880
Mailing Address - Fax:
Practice Address - Street 1:22174 TIMBERLAKE RD STE D
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5055
Practice Address - Country:US
Practice Address - Phone:434-525-9006
Practice Address - Fax:800-486-0913
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health