Provider Demographics
NPI:1093254310
Name:SLADE, KHALILAH Z (LCMHC, LCAS)
Entity Type:Individual
Prefix:
First Name:KHALILAH
Middle Name:Z
Last Name:SLADE
Suffix:
Gender:F
Credentials:LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SUNCREST CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-4913
Mailing Address - Country:US
Mailing Address - Phone:919-454-5383
Mailing Address - Fax:
Practice Address - Street 1:800 PARK OFFICES DR
Practice Address - Street 2:SUITE 3410
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27709-2770
Practice Address - Country:US
Practice Address - Phone:919-355-6449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22239101YA0400X
NC13696101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional