Provider Demographics
NPI:1043083207
Name:SKUDARNOV, MORGAN (LMSW)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:SKUDARNOV
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:GUTHRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:972 OAKLEY LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-6330
Mailing Address - Country:US
Mailing Address - Phone:470-345-3372
Mailing Address - Fax:
Practice Address - Street 1:1435 HAW CREEK CIR E STE 403
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6567
Practice Address - Country:US
Practice Address - Phone:678-834-9274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW011596104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker