Provider Demographics
NPI:1487117347
Name:SCOTT, LATOSHA (LCSWA)
Entity type:Individual
Prefix:MISS
First Name:LATOSHA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 W CRESCENT SQUARE DR APT F
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-4041
Mailing Address - Country:US
Mailing Address - Phone:336-504-7768
Mailing Address - Fax:
Practice Address - Street 1:3711 UNIVERSITY DR STE C
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6205
Practice Address - Country:US
Practice Address - Phone:919-405-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0122871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012287Medicaid