Provider Demographics
NPI:1598461782
Name:SKELTON MENDOZA GIL, KIRA LEONOR
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:LEONOR
Last Name:SKELTON MENDOZA GIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BRANCH HILL LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7450
Mailing Address - Country:US
Mailing Address - Phone:175-475-7665
Mailing Address - Fax:
Practice Address - Street 1:426 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3414
Practice Address - Country:US
Practice Address - Phone:803-814-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8353101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health