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Individual
MR. SCOTT WESTON MANDEVILLE
Active
Individual
MR. SCOTT WESTON MANDEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.C.S.W., CS.O.T.P.
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904002990
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891959169
—
VA
01
—
219164
COM-PSYCH
VA
01
—
462838
ANTHEM
VA
01
—
828523000
MAGELLAN
VA
01
—
O86454M
SENTARA
VA
Enumeration date
03/29/2006
Last updated
12/13/2012
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