Provider Demographics
NPI:1710435656
Name:SLADE, CARENDA (EDD)
Entity Type:Individual
Prefix:DR
First Name:CARENDA
Middle Name:
Last Name:SLADE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7790 LEANING PINE CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4429
Mailing Address - Country:US
Mailing Address - Phone:706-412-0145
Mailing Address - Fax:
Practice Address - Street 1:7790 LEANING PINE CT
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-4429
Practice Address - Country:US
Practice Address - Phone:706-412-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional