Provider Demographics
NPI:1891233144
Name:SKELLEY, ALEXIS ANN (LCSW, LISW-CP, CDE)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANN
Last Name:SKELLEY
Suffix:
Gender:F
Credentials:LCSW, LISW-CP, CDE
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:SKELLEY
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 71256
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-0039
Mailing Address - Country:US
Mailing Address - Phone:843-450-2727
Mailing Address - Fax:843-564-3634
Practice Address - Street 1:1608 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3572
Practice Address - Country:US
Practice Address - Phone:843-450-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0094751041C0700X
174H00000X
SC1222321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty