Individual
CECILIA MAE SKIDMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., L.P.C.
Contact information
Practice address
1514 WEALTHY ST SE, SUITE 260, GRAND RAPIDS, MI 49506-2755
(616) 451-3008
Mailing address
1554 MACKINAW RD SE, GRAND RAPIDS, MI 49506-3349
(616) 241-2413
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401001787
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6401001767
COUNSELOR LICENSE
MI
Enumeration date
01/16/2007
Last updated
07/08/2007
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