Provider Demographics
NPI:1972544831
Name:WHITESELL, SCOT ALAN (LCPC)
Entity Type:Individual
Prefix:MR
First Name:SCOT
Middle Name:ALAN
Last Name:WHITESELL
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6355
Mailing Address - Country:US
Mailing Address - Phone:410-569-9592
Mailing Address - Fax:410-569-9592
Practice Address - Street 1:2504 CRESWELL RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6510
Practice Address - Country:US
Practice Address - Phone:410-569-9592
Practice Address - Fax:410-569-9592
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0793101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000167800Medicaid