Healthcare Provider Details

I. General information

NPI: 1194892562
Provider Name (Legal Business Name): WANDA R SCOTT LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 PENNSYLVANIA AVE SE
WASHINGTON DC
20003-2227
US

IV. Provider business mailing address

8487 RIVER RATTLER LN W APT 201
MILLINGTON TN
38053-5054
US

V. Phone/Fax

Practice location:
  • Phone: 202-826-1183
  • Fax: 901-300-3840
Mailing address:
  • Phone: 202-826-1183
  • Fax: 901-300-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50081297
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: