Provider Demographics
NPI:1477531994
Name:SKOGLUND, CONSTANCE JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:JEAN
Last Name:SKOGLUND
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:PO BOX 53280
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-3280
Mailing Address - Country:US
Mailing Address - Phone:910-485-7005
Mailing Address - Fax:910-485-8629
Practice Address - Street 1:103 FOUNTAINHEAD LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5462
Practice Address - Country:US
Practice Address - Phone:910-485-7005
Practice Address - Fax:910-485-8629
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0003331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC76762OtherBC/BS PROVIDER #