Individual
MR. SHANE ANDREW SKINNER SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDP
Contact information
Practice address
404 W MAIN ST, KELSO, WA 98626-1118
(360) 423-2806
(360) 423-2806
Mailing address
404 W MAIN ST, KELSO, WA 98626-1118
(360) 423-2806
(360) 423-2806
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60688887
WA
Other
Enumeration date
10/30/2018
Last updated
10/30/2018
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