Provider Demographics
NPI:1285173005
Name:TOWNS-SCOTT, MATTIE DIANN (LISW-S, LICDC)
Entity type:Individual
Prefix:
First Name:MATTIE
Middle Name:DIANN
Last Name:TOWNS-SCOTT
Suffix:
Gender:F
Credentials:LISW-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 ROBERTDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2549
Mailing Address - Country:US
Mailing Address - Phone:216-224-7080
Mailing Address - Fax:440-439-4548
Practice Address - Street 1:5845 ROBERTDALE ROAD
Practice Address - Street 2:
Practice Address - City:OAKWOOD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44146-2549
Practice Address - Country:US
Practice Address - Phone:216-224-7080
Practice Address - Fax:440-439-4548
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.19015781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLICDC.162056OtherOHIO CHEMICAL DEPENDENCY PROFESSIONALS BOARD