MEDICARE: MS. TAKISHA LASHAWN SKINNER MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	0906012018	VA

General Provider Information

NPI Number	:	1265185300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAKISHA LASHAWN SKINNER MSW

Provider Business Mailing Address
First Line	:	107 CORAL REEF CT
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-4506
Country	:	US
Telephone Number	:	571-535-4629
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 CORAL REEF CT
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-4506
Country	:	US
Telephone Number	:	571-535-4629
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2022
Last Update Date	:	01/29/2022

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