Provider Demographics
NPI:1962111708
Name:SCOTT, SHANNON STEPHANIE (LPCA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:STEPHANIE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9699 SEED ST
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-6746
Mailing Address - Country:US
Mailing Address - Phone:843-557-4303
Mailing Address - Fax:
Practice Address - Street 1:320 MIDLAND PKWY STE C
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7195
Practice Address - Country:US
Practice Address - Phone:843-871-4790
Practice Address - Fax:844-965-9336
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8057101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional