Healthcare Provider Details

I. General information

NPI: 1003319815
Provider Name (Legal Business Name): LAVERNE LATRICE SCOTT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 03/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 14TH ST
COLUMBUS GA
31906-2005
US

IV. Provider business mailing address

2237 14TH ST
COLUMBUS GA
31906-2005
US

V. Phone/Fax

Practice location:
  • Phone: 334-768-6411
  • Fax:
Mailing address:
  • Phone: 334-868-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLSW2470
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: