Provider Demographics
NPI:1255410247
Name:SLAUGHTER, HAROLD D (MS)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:D
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S RALEIGH STREET
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401
Mailing Address - Country:US
Mailing Address - Phone:304-263-9095
Mailing Address - Fax:304-263-9097
Practice Address - Street 1:431 S RALEIGH STREET
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-263-9095
Practice Address - Fax:304-263-9097
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV202103T00000X
WV22004103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000547071OtherBLUE CROSS BLUE SHIELD
WV0165399000Medicaid
WVSL0606701Medicare ID - Type Unspecified