Provider Demographics
NPI:1144057357
Name:SCOTT, ETHENIA ALICEE (C-EM)
Entity type:Individual
Prefix:MS
First Name:ETHENIA
Middle Name:ALICEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:C-EM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 PEACHTREE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3209
Mailing Address - Country:US
Mailing Address - Phone:838-333-3989
Mailing Address - Fax:
Practice Address - Street 1:260 PEACHTREE ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1202
Practice Address - Country:US
Practice Address - Phone:838-333-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
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No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist