Healthcare Provider Details

I. General information

NPI: 1821743949
Provider Name (Legal Business Name): HOPE GABRIENNA SKIPWORTH CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/17/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PARK AVE
HILLSBORO OH
45133-1315
US

IV. Provider business mailing address

205 PARK AVE
HILLSBORO OH
45133-1315
US

V. Phone/Fax

Practice location:
  • Phone: 937-840-8462
  • Fax:
Mailing address:
  • Phone: 937-840-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberUT664455
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberUC664455
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: