Basic Information
| Provider Information | |||||||||
| NPI: | 1235267873 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5310 E MAIN ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432132598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143558000 | ||||||||
| FaxNumber: | 6143558018 | ||||||||
| Practice Location | |||||||||
| Address1: | 1329 CHERRY WAY DR | ||||||||
| Address2: | STE 605 | ||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432306777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147511090 | ||||||||
| FaxNumber: | 6147511091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 12/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I5462 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.