Provider Demographics
NPI:1093984528
Name:SLAUGHTER, CHARRISE
Entity Type:Individual
Prefix:
First Name:CHARRISE
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1948
Mailing Address - Country:US
Mailing Address - Phone:510-886-8696
Mailing Address - Fax:
Practice Address - Street 1:684 MEMORIAL WAY
Practice Address - Street 2:7
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-5835
Practice Address - Country:US
Practice Address - Phone:510-886-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)