Provider Demographics
NPI:1952707507
Name:SCOTT, ROXANA PRINCE (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:ROXANA
Middle Name:PRINCE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PLYMOUTH RD APT L4
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1463
Mailing Address - Country:US
Mailing Address - Phone:734-674-8548
Mailing Address - Fax:
Practice Address - Street 1:3646 MOUNT ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2311
Practice Address - Country:US
Practice Address - Phone:313-348-5507
Practice Address - Fax:313-924-0605
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6041018282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional