Provider Demographics
NPI:1346207511
Name:SLANE, ELIZABETH DACUS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:DACUS
Last Name:SLANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3541 RANDOLPH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1032
Mailing Address - Country:US
Mailing Address - Phone:704-365-1450
Mailing Address - Fax:704-366-6464
Practice Address - Street 1:3541 RANDOLPH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1032
Practice Address - Country:US
Practice Address - Phone:704-365-1450
Practice Address - Fax:704-366-6464
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0007671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7684NOtherBCBS PROVIDER NUMBER
NC1817536OtherAETNA PROVIDER NUMBER
NC6002053Medicaid