Provider Demographics
NPI:1093751273
Name:SKINNER, MARVIN EUGENE (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:EUGENE
Last Name:SKINNER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-2307
Mailing Address - Country:US
Mailing Address - Phone:434-634-6992
Mailing Address - Fax:434-336-0835
Practice Address - Street 1:158 PLEASANT SHADE DR
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-7837
Practice Address - Country:US
Practice Address - Phone:434-348-9071
Practice Address - Fax:434-336-0835
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA188273Medicaid
VA4945280Medicaid
VA086374Medicaid