Provider Demographics
NPI:1205436268
Name:SKINNER, JOSETTE HOFFMAN (LCASA)
Entity type:Individual
Prefix:
First Name:JOSETTE
Middle Name:HOFFMAN
Last Name:SKINNER
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PARK DR SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7029
Mailing Address - Country:US
Mailing Address - Phone:704-701-1832
Mailing Address - Fax:
Practice Address - Street 1:51 PARK DR SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7029
Practice Address - Country:US
Practice Address - Phone:704-701-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-26785101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)