Provider Demographics
NPI:1790005882
Name:SKEETER, KIMBERLY L (MA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:SKEETER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 WIMBLEDON DR APT 22
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5382
Mailing Address - Country:US
Mailing Address - Phone:757-777-4288
Mailing Address - Fax:
Practice Address - Street 1:2428 CHARLES BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5924
Practice Address - Country:US
Practice Address - Phone:252-215-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional