=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598061822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAMIKA GLENETTA SCOTT L.P.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2011
-----------------------------------------------------
Last Update Date | 02/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7725 ST. ANDREWS RD. SUITE 4
-----------------------------------------------------
City | IRMO
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-665-8532
-----------------------------------------------------
Fax | 803-749-3290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 211041
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-665-8532
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 5185
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------