Healthcare Provider Details

I. General information

NPI: 1912363813
Provider Name (Legal Business Name): CARLINE SCUTT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WINN WAY
DECATUR GA
30030
US

IV. Provider business mailing address

233 TOWNSHIP LINE RD 2A
ELKINS PARK PA
19027-2258
US

V. Phone/Fax

Practice location:
  • Phone: 404-892-4646
  • Fax:
Mailing address:
  • Phone: 267-939-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC009314
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number251E00000X
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: