Provider Demographics
NPI:1497828982
Name:SKINNER, LAURA ROEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ROEL
Last Name:SKINNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6186 MOUNTAIN VINE AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-9049
Mailing Address - Country:US
Mailing Address - Phone:980-222-4999
Mailing Address - Fax:
Practice Address - Street 1:20901 TORRENCE CHAPEL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4301
Practice Address - Country:US
Practice Address - Phone:980-222-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2435103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0400HOtherBCBS PROVIDER #