Provider Demographics
NPI:1255390860
Name:SCOTT, LINDA E (PHD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:E
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:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-0639
Mailing Address - Country:US
Mailing Address - Phone:804-526-0220
Mailing Address - Fax:804-526-0224
Practice Address - Street 1:320 C CHARLES DIMMOCK PARKWAY
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-526-0220
Practice Address - Fax:804-526-0224
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001110103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007714360Medicaid
VAC10417OtherMEDICARE GROUP NUMBER
VAC10417OtherMEDICARE GROUP NUMBER
R60629Medicare UPIN