Provider Demographics
NPI:1003984196
Name:SKINNER, JENNIFER CAROLYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CAROLYN
Last Name:SKINNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:CAROLYN
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1572 SCHOOLVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213
Mailing Address - Country:US
Mailing Address - Phone:601-366-3564
Mailing Address - Fax:
Practice Address - Street 1:350 NORTH MART PLAZA
Practice Address - Street 2:SUITE M
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206
Practice Address - Country:US
Practice Address - Phone:601-362-8850
Practice Address - Fax:601-981-0452
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC12771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124149Medicaid
MS00124149Medicaid