Provider Demographics
NPI:1154722353
Name:SKIDMORE, BRANDY MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:MICHELLE
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BRANDY
Other - Middle Name:MICHELLE
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4400A AMBASSADOR CAFFERY PKWY # 167
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6706
Mailing Address - Country:US
Mailing Address - Phone:337-450-0406
Mailing Address - Fax:
Practice Address - Street 1:601 TEEMA RD
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520
Practice Address - Country:US
Practice Address - Phone:337-521-7640
Practice Address - Fax:337-521-7641
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA109271041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool