Provider Demographics
NPI:1184607582
Name:SCOTT, ALICE MALONE (PHD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:MALONE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 HIGHWAY 45 SOUTH
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:TN
Mailing Address - Zip Code:38366
Mailing Address - Country:US
Mailing Address - Phone:304-476-0144
Mailing Address - Fax:
Practice Address - Street 1:3700 HWY 45 S
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:TN
Practice Address - Zip Code:38366
Practice Address - Country:US
Practice Address - Phone:304-476-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00942306104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001720369OtherMS BCBS
WV3810002108Medicaid
R94822Medicare UPIN
WVSW29056Medicare PIN