Basic Information
| Provider Information | |||||||||
| NPI: | 1912363813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCUTT | ||||||||
| FirstName: | CARLINE | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 233 TOWNSHIP LINE RD | ||||||||
| Address2: | 2A | ||||||||
| City: | ELKINS PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190272258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2679390617 | ||||||||
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| Practice Location | |||||||||
| Address1: | 445 WINN WAY | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048924646 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2016 | ||||||||
| LastUpdateDate: | 08/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 251E00000X | PA | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 101Y00000X | LPC009314 | GA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.