Provider Demographics
NPI:1801849088
Name:SLOAN, JERRY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:SLOAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 CANTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7300
Mailing Address - Country:US
Mailing Address - Phone:910-763-2385
Mailing Address - Fax:910-763-1482
Practice Address - Street 1:2311 CANTERWOOD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7300
Practice Address - Country:US
Practice Address - Phone:910-763-2385
Practice Address - Fax:910-763-1482
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC340103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical