Provider Demographics
NPI:1083122287
Name:SKINNER, DWIGHT MERLE II
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:MERLE
Last Name:SKINNER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 INDIAN HEAD RD
Mailing Address - Street 2:
Mailing Address - City:CHAMPION
Mailing Address - State:PA
Mailing Address - Zip Code:15622-3019
Mailing Address - Country:US
Mailing Address - Phone:724-455-2122
Mailing Address - Fax:724-455-6651
Practice Address - Street 1:2166 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:CHAMPION
Practice Address - State:PA
Practice Address - Zip Code:15622-3019
Practice Address - Country:US
Practice Address - Phone:724-455-2122
Practice Address - Fax:724-455-6651
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional