Provider Demographics
NPI:1366170409
Name:SKINNER, JESSICA HEATHER (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HEATHER
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 M L KING JR BLVD # 175
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2209
Mailing Address - Country:US
Mailing Address - Phone:252-620-1957
Mailing Address - Fax:
Practice Address - Street 1:510A POLLOCK ST
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5612
Practice Address - Country:US
Practice Address - Phone:252-620-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0175321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical