Healthcare Provider Details

I. General information

NPI: 1508136433
Provider Name (Legal Business Name): STEPHANIE D SCOTT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3282 WELLONS BLVD
NEW BERN NC
28562-5234
US

IV. Provider business mailing address

3282 WELLONS BLVD
NEW BERN NC
28562-5234
US

V. Phone/Fax

Practice location:
  • Phone: 252-745-7401
  • Fax: 252-745-7400
Mailing address:
  • Phone: 252-571-1100
  • Fax: 252-351-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE DIANE SCOTT
Title or Position: OWNER
Credential: MED, LCMHCS, NCC
Phone: 252-571-1100