Provider Demographics
NPI:1235746637
Name:SCOTT, DESIREE CHANTEL
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:CHANTEL
Last Name:SCOTT
Suffix:
Gender:
Credentials:
Other - Prefix:MISS
Other - First Name:DESIREE
Other - Middle Name:CHANTEL
Other - Last Name:STILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA, SW-T
Mailing Address - Street 1:3094 W MARKET ST STE 343
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3618
Mailing Address - Country:US
Mailing Address - Phone:234-334-5589
Mailing Address - Fax:
Practice Address - Street 1:3094 W MARKET ST STE 343
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3618
Practice Address - Country:US
Practice Address - Phone:234-334-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.174315101YA0400X
171M00000X, 171M00000X
OHS.2411035104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker