Provider Demographics
NPI:1194322446
Name:SKINNER, CHEYENNE GRACE
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:GRACE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:G
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHEYENNE SKINNER MSW
Mailing Address - Street 1:3103 CLAIRMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1043
Mailing Address - Country:US
Mailing Address - Phone:770-713-6840
Mailing Address - Fax:
Practice Address - Street 1:3103 CLAIRMONT RD NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1043
Practice Address - Country:US
Practice Address - Phone:770-713-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty