Provider Demographics
NPI:1962675710
Name:SKAGGS, DANA BATES (MA)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:BATES
Last Name:SKAGGS
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 1:302 SUNSET DRIVE, SUITE 105
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-282-1930
Mailing Address - Fax:423-283-0608
Practice Address - Street 1:302 SUNSET DR
Practice Address - Street 2:SUITE 105
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2408
Practice Address - Country:US
Practice Address - Phone:423-282-1930
Practice Address - Fax:423-283-0608
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1716103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist