Provider Information for 1629787338
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Miss PHYLLIS LATRICE SKEETER LCSW
Other Names:Professional Name:N/A N/A N/A LCSWSex: Female
NPI: 1629787338
Last Updated: 2022-11-21
Certification Date: 2022-11-12
Certification Date: 2022-11-12
Details
| Name | Value | |||||||||||||||||||||
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| NPI | 1629787338 | |||||||||||||||||||||
| Enumeration Date | 2022-11-21 | |||||||||||||||||||||
| NPI Type | NPI-1 Individual | |||||||||||||||||||||
| Sole Proprietor | NO | |||||||||||||||||||||
| Status | Active | |||||||||||||||||||||
| Mailing Address | 1121 COLUMBIA ST PORTSMOUTH, VA 23704-4175 United States Phone: 757-237-1142 | Fax: | |||||||||||||||||||||
| Primary Practice Address | 1121 COLUMBIA ST PORTSMOUTH, VA 23704-4175 United States Phone: 757-237-1142 | Fax: | |||||||||||||||||||||
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