Provider Demographics
NPI:1013307933
Name:SLAUGHTER, RENEA (LCSW)
Entity Type:Individual
Prefix:
First Name:RENEA
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2957 FESTIVAL WAY STE 123
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2959
Mailing Address - Country:US
Mailing Address - Phone:803-422-4892
Mailing Address - Fax:
Practice Address - Street 1:5000 THAYER CTR STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1139
Practice Address - Country:US
Practice Address - Phone:703-718-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000015071041C0700X
MD280951041C0700X
VA09040113271041C0700X
NCC0087471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904011327OtherLICENSE
MD28095OtherLICENSE
NCC008747OtherLICENSE
DCLC200001507OtherLICENSE