Provider Demographics
NPI:1154752673
Name:SCOTT, TABITHA A (LCSW)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCSW
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 86
Mailing Address - Street 2:
Mailing Address - City:CAMP MEEKER
Mailing Address - State:CA
Mailing Address - Zip Code:95419-0086
Mailing Address - Country:US
Mailing Address - Phone:707-494-2057
Mailing Address - Fax:
Practice Address - Street 1:9291 OLD REDWOOD HWY # 500
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-8089
Practice Address - Country:US
Practice Address - Phone:707-837-7767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA830621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical