Provider Demographics
NPI:1346883543
Name:SLOAN, JESSICA MARIE SOLIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE SOLIS
Last Name:SLOAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 LAKE BOONE TRL STE 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7511
Mailing Address - Country:US
Mailing Address - Phone:919-442-1123
Mailing Address - Fax:919-785-0038
Practice Address - Street 1:4201 LAKE BOONE TRL STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7511
Practice Address - Country:US
Practice Address - Phone:919-442-1123
Practice Address - Fax:919-785-0038
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5428103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty