1912440785 NPI number — SUZANNE MICHELLE SKINNER MSW, LISW-CP-S

Table of content: SUZANNE MICHELLE SKINNER MSW, LISW-CP-S (NPI 1912440785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912440785 NPI number — SUZANNE MICHELLE SKINNER MSW, LISW-CP-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKINNER
Provider First Name:
SUZANNE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LISW-CP-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAKARSKI
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912440785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2141
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRMO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29063-7141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-319-0910
Provider Business Mailing Address Fax Number:
803-403-0337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7803 SAINT ANDREWS ROAD
Provider Second Line Business Practice Location Address:
SUITE C2
Provider Business Practice Location Address City Name:
IRMO
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-319-0910
Provider Business Practice Location Address Fax Number:
803-563-5930
Provider Enumeration Date:
11/28/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  8950 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)