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General NPI Number Information
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NPI Number | 1609445238
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Entity Type | Individual
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Provider Name | KATELYN SKINNER JANVRIN MA, LCMHCA, NCC
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Gender | Female
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 18151 W CATAWBA AVE
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City | CORNELIUS
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State | NC
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Zip | 28031-5641
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Country | US
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Telephone | 704-644-9516
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Fax | 704-445-3030
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Provider Business Mailing Address
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Address Line | 130 SHOVELHEAD LN
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City | STATESVILLE
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State | NC
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Zip | 28625-1148
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Country | US
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Telephone | 704-644-9516
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Fax | 704-445-3030
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A16642
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License Number State | NC
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