Provider Demographics
NPI:1831554245
Name:SKINNER, THERESE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:MARIE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:MARIE
Other - Last Name:WIKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 N PIERCE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5379
Mailing Address - Country:US
Mailing Address - Phone:501-603-2147
Mailing Address - Fax:
Practice Address - Street 1:1405 N PIERCE ST STE 101
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5379
Practice Address - Country:US
Practice Address - Phone:501-603-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7331-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker