Basic Information
Provider Information | |||||||||
NPI: | 1396388088 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCOTT | ||||||||
FirstName: | LEVETTE | ||||||||
MiddleName: | SUBRAINA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHD LPC-A NCC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DAMES | ||||||||
OtherFirstName: | LEVETTE | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PHD LPC-A NCC | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 284 EXECUTIVE PARK DR STE 100 | ||||||||
Address2: |   | ||||||||
City: | CONCORD | ||||||||
State: | NC | ||||||||
PostalCode: | 280251833 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7049391100 | ||||||||
FaxNumber: | 7049391173 | ||||||||
Practice Location | |||||||||
Address1: | 943 W ANDREWS AVE STE H | ||||||||
Address2: |   | ||||||||
City: | HENDERSON | ||||||||
State: | NC | ||||||||
PostalCode: | 275362562 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2524330061 | ||||||||
FaxNumber: | 2524330065 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/24/2019 | ||||||||
LastUpdateDate: | 12/02/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 1165636 | NC | N |   | Behavioral Health & Social Service Providers | Counselor |   | 101YS0200X | 1187002 | NC | N |   | Behavioral Health & Social Service Providers | Counselor | School | 101YM0800X | A15071 | NC | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.