Provider Demographics
NPI:1215277553
Name:MCDANIEL, SCOTT DOUGLAS (LPC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DOUGLAS
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 AVENUE B NE STE D
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2746
Mailing Address - Country:US
Mailing Address - Phone:706-331-1757
Mailing Address - Fax:
Practice Address - Street 1:808 AVENUE B NE STE D
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2746
Practice Address - Country:US
Practice Address - Phone:706-331-1757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003135223AMedicaid