Provider Demographics
NPI:1356796932
Name:SCOTT, YANISSE (LISW-CP)
Entity type:Individual
Prefix:
First Name:YANISSE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 HAMPTON ST STE G
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2924
Mailing Address - Country:US
Mailing Address - Phone:803-403-4506
Mailing Address - Fax:
Practice Address - Street 1:1517 HAMPTON ST STE G
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2924
Practice Address - Country:US
Practice Address - Phone:803-403-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC98201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical