Provider Demographics
NPI:1417270398
Name:SKUCE, KORAH SCHAFFERT (LCSW)
Entity Type:Individual
Prefix:
First Name:KORAH
Middle Name:SCHAFFERT
Last Name:SKUCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FRIENDLY LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3605
Mailing Address - Country:US
Mailing Address - Phone:252-412-5550
Mailing Address - Fax:252-412-5550
Practice Address - Street 1:114 FRIENDLY LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-3605
Practice Address - Country:US
Practice Address - Phone:252-412-5550
Practice Address - Fax:252-412-5550
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0065311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006720Medicaid