1497057962 NPI number — DR. SHANNON HARGROVE-SCOTT EDD,MSW,LCSW,LCASA

Table of content: DR. SHANNON HARGROVE-SCOTT EDD,MSW,LCSW,LCASA (NPI 1497057962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497057962 NPI number — DR. SHANNON HARGROVE-SCOTT EDD,MSW,LCSW,LCASA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARGROVE-SCOTT
Provider First Name:
SHANNON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
EDD,MSW,LCSW,LCASA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497057962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63 W WAYCLIFF RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27537-6933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-767-2246
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 HORNER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27536-4128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-767-2246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LCAS-2569 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C008062 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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