Healthcare Provider Details

I. General information

NPI: 1245152305
Provider Name (Legal Business Name): KEYONT'E SCOTT DHSC, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16930 W CATAWBA AVE STE 200
CORNELIUS NC
28031-5639
US

IV. Provider business mailing address

2105 PRIMM FARMS DR
CHARLOTTE NC
28216-5389
US

V. Phone/Fax

Practice location:
  • Phone: 704-322-4020
  • Fax:
Mailing address:
  • Phone: 843-337-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP016882
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: