Provider Demographics
NPI:1972754661
Name:SLAUGHTER, STEPHANIE ANN (MSW, LCSW, LCAS-A)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANN
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1894
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:943 W ANDREWS AVE STE H
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2562
Practice Address - Country:US
Practice Address - Phone:252-433-0061
Practice Address - Fax:252-738-2460
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-A 2833101YA0400X
NCC0061911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007216Medicaid
NCLCAS-A 2833OtherNORTH CAROLINA SUBSTANCE ABUSE PROFESSIONAL PRACTICE BOARD
NCC006191OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD
NC155WYOtherBCBS OF NC
NC2853479Medicare PIN