Provider Demographics
NPI:1669111431
Name:SLAUGHTER, CLARENCE EDWARD JR (LICSW)
Entity type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:EDWARD
Last Name:SLAUGHTER
Suffix:JR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 BROAD BRANCH CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-6463
Mailing Address - Country:US
Mailing Address - Phone:314-540-3115
Mailing Address - Fax:
Practice Address - Street 1:3015 BROAD BRANCH CIR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-6463
Practice Address - Country:US
Practice Address - Phone:314-540-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000052441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical