MEDICARE: CARMALITA G ESCOTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0732007107	VA

General Provider Information

NPI Number	:	1932873528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMALITA G ESCOTO

Provider Business Mailing Address
First Line	:	PO BOX 573
Second Line	:
City	:	CHARLOTTE COURT HOUSE
State	:	VA
Zip	:	23923-0573
Country	:	US
Telephone Number	:	434-390-9335
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 CARDINAL DR
Second Line	:
City	:	CHARLOTTE COURT HOUSE
State	:	VA
Zip	:	23923-3789
Country	:	US
Telephone Number	:	434-390-9335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2021
Last Update Date	:	08/06/2021

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