Provider Demographics
NPI:1447918453
Name:SCOGGINS, SYDNEY THOMAS (LICSW)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:THOMAS
Last Name:SCOGGINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 DAPHNE AVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4297
Mailing Address - Country:US
Mailing Address - Phone:251-621-5360
Mailing Address - Fax:251-621-5361
Practice Address - Street 1:805 DAPHNE AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4297
Practice Address - Country:US
Practice Address - Phone:251-621-5360
Practice Address - Fax:251-621-5361
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4913C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical