Provider Demographics
NPI:1962241422
Name:SCOTT, TIERRA MOCHELLRIE
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:MOCHELLRIE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PINCKNEY ST. C1
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706
Mailing Address - Country:US
Mailing Address - Phone:803-899-2962
Mailing Address - Fax:
Practice Address - Street 1:102 PINCKNEY ST. C1
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706
Practice Address - Country:US
Practice Address - Phone:803-899-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103573369106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician