Provider Demographics
NPI:1457033375
Name:SCOTT, JESSICA NICOLE (EDS, PC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NICOLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:EDS, PC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 CHADWYCK CIR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3168
Mailing Address - Country:US
Mailing Address - Phone:478-918-3494
Mailing Address - Fax:
Practice Address - Street 1:119 CHADWYCK CIR
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3168
Practice Address - Country:US
Practice Address - Phone:478-918-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X, 101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional