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Individual
MR. MICKEY SKIDMORE
Active
Individual
MR. MICKEY SKIDMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACSW, LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C000177
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2091760
CIGNA PROVIDER #
NC
01
—
3221
CBHA PROVIDER #
NC
05
—
6002624
—
NC
01
—
76734
BCBS PROVIDER #
NC
01
—
C4769
MEDCOST PROVIDER #
NC
Enumeration date
09/13/2005
Last updated
07/09/2007
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