Provider Demographics
NPI:1306303110
Name:SCOTT, JACLYN MARIE (LPC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 MCCAULEY ST
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-2725
Mailing Address - Country:US
Mailing Address - Phone:910-200-9515
Mailing Address - Fax:
Practice Address - Street 1:1359 MCCAULEY ST
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-2725
Practice Address - Country:US
Practice Address - Phone:910-200-9515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8405101Y00000X
VA0701007042101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor