Individual
MR. DERRICK SKINNER SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
12647 OLIVE BLVD, STE 600, SAINT LOUIS, MO 63141-6393
(800) 325-3982
(877) 685-9880
Mailing address
USA MEDDAC, 11050 MOUNT BELVEDERE BLVD, FORT DRUM, NY 13602-5438
(315) 772-3173
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1041
NE
104100000X
Social Worker
2406
NE
1041C0700X
Clinical Social Worker
1041
NE
1041C0700X
Clinical Social Worker
2406
NE
Other
Enumeration date
12/09/2009
Last updated
02/16/2022
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