Provider Demographics
NPI:1114703790
Name:SLONECKER, SHELLY LYNN (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:SLONECKER
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 MITTGLEN LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-5302
Mailing Address - Country:US
Mailing Address - Phone:614-940-3105
Mailing Address - Fax:
Practice Address - Street 1:113 EDINBURGH SOUTH DR STE 130
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6456
Practice Address - Country:US
Practice Address - Phone:919-462-8303
Practice Address - Fax:919-462-0433
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0189911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical