Provider Demographics
NPI:1083473938
Name:SLAVIN, JACLYN L (LPCMH)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:L
Last Name:SLAVIN
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S BANCROFT PKWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3707
Mailing Address - Country:US
Mailing Address - Phone:302-650-5600
Mailing Address - Fax:
Practice Address - Street 1:1200 N FRENCH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-3239
Practice Address - Country:US
Practice Address - Phone:302-652-3948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health