Provider Demographics
NPI:1013495811
Name:SCRUGGS, MATTHEW WHITE (ALC, NCC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WHITE
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 EDMONTON DR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-4878
Mailing Address - Country:US
Mailing Address - Phone:205-425-1200
Mailing Address - Fax:
Practice Address - Street 1:4204 EDMONTON DR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4878
Practice Address - Country:US
Practice Address - Phone:205-425-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
AL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty