Provider Demographics
NPI:1346683760
Name:SKIADAS, STEVE HENRY
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:HENRY
Last Name:SKIADAS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:STEVE
Other - Middle Name:HENRY
Other - Last Name:SKIADAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAC
Mailing Address - Street 1:8141B FOREST OAK WAY
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-0655
Mailing Address - Country:US
Mailing Address - Phone:619-370-0593
Mailing Address - Fax:
Practice Address - Street 1:8141B FOREST OAK WAY
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-0655
Practice Address - Country:US
Practice Address - Phone:619-370-0593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12962101YA0400X
IN12962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional