Provider Demographics
NPI:1730499559
Name:SLOCUM, CHRISTY T (LISW-CP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:T
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 TIPPERARY LN
Mailing Address - Street 2:
Mailing Address - City:WEDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29168-9370
Mailing Address - Country:US
Mailing Address - Phone:803-381-6033
Mailing Address - Fax:803-462-4848
Practice Address - Street 1:2575 LIN DO CT STE C
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1832
Practice Address - Country:US
Practice Address - Phone:803-381-6033
Practice Address - Fax:803-462-4848
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC96311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ46545D520Medicare Oscar/Certification