Healthcare Provider Details

I. General information

NPI: 1124332895
Provider Name (Legal Business Name): GINA E SKINNER CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 MISSION HILL RD
TULALIP WA
98271-9706
US

IV. Provider business mailing address

11 PRIEST POINT DR NE
TULALIP WA
98271-7323
US

V. Phone/Fax

Practice location:
  • Phone: 360-716-4323
  • Fax:
Mailing address:
  • Phone: 206-579-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00002475
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: