Provider Demographics
NPI:1821743949
Name:SKIPWORTH, HOPE GABRIENNA (CDCA)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:GABRIENNA
Last Name:SKIPWORTH
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1315
Mailing Address - Country:US
Mailing Address - Phone:937-840-8462
Mailing Address - Fax:
Practice Address - Street 1:205 PARK AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1315
Practice Address - Country:US
Practice Address - Phone:937-840-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUC664455390200000X
OHUT664455101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program