Provider Demographics
NPI:1871711390
Name:SCOTT, JANET M
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JANET
Other - Middle Name:M
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1554 FREDRICKSBERG DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4662
Mailing Address - Country:US
Mailing Address - Phone:770-912-2692
Mailing Address - Fax:
Practice Address - Street 1:1554 FREDRICKSBERG DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4662
Practice Address - Country:US
Practice Address - Phone:770-912-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional