Healthcare Provider Details

I. General information

NPI: 1033343512
Provider Name (Legal Business Name): DOREEN SCOTT LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OWINGS CT SUITE 8
REISTERSTOWN MD
21136-6428
US

IV. Provider business mailing address

10400 RIDGLAND RD
COCKEYSVILLE MD
21030-2715
US

V. Phone/Fax

Practice location:
  • Phone: 410-526-7100
  • Fax:
Mailing address:
  • Phone: 410-628-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC1482
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: