Provider Demographics
NPI:1851896542
Name:SLAY, CICELY
Entity Type:Individual
Prefix:
First Name:CICELY
Middle Name:
Last Name:SLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9728 FAIRES FARM RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4211
Mailing Address - Country:US
Mailing Address - Phone:404-268-7754
Mailing Address - Fax:704-910-3628
Practice Address - Street 1:3225 LASALLE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4949
Practice Address - Country:US
Practice Address - Phone:980-498-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 251K00000X, 253Z00000X, 261QC1500X
NC874693497347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health