Provider Demographics
NPI:1811982010
Name:SKIDMORE, MICKEY (ACSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:MICKEY
Middle Name:
Last Name:SKIDMORE
Suffix:
Gender:M
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 39TH AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9065
Mailing Address - Country:US
Mailing Address - Phone:828-302-3434
Mailing Address - Fax:
Practice Address - Street 1:926 2ND ST NE
Practice Address - Street 2:SUITE #306
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3869
Practice Address - Country:US
Practice Address - Phone:828-302-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-07-09
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NCC0001771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002624Medicaid
NCC4769OtherMEDCOST PROVIDER #
NC2091760OtherCIGNA PROVIDER #
NC3221OtherCBHA PROVIDER #
NC76734OtherBCBS PROVIDER #
NC6002624Medicaid