Provider Demographics
NPI:1801238126
Name:BURRELL, SCOTIA D (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SCOTIA
Middle Name:D
Last Name:BURRELL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5834 FARINGDON PL STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3930
Mailing Address - Country:US
Mailing Address - Phone:919-295-0596
Mailing Address - Fax:919-249-7697
Practice Address - Street 1:5834 FARINGDON PL STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3930
Practice Address - Country:US
Practice Address - Phone:919-295-0596
Practice Address - Fax:919-249-7697
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-28
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0084631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical