Provider Demographics
NPI:1750696001
Name:E. WAYNE SLOOP, PH.D., PC
Entity type:Organization
Organization Name:E. WAYNE SLOOP, PH.D., PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:E.
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SLOOP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:434-237-7792
Mailing Address - Street 1:20715 TIMBERLAKE ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-7207
Mailing Address - Country:US
Mailing Address - Phone:434-237-7792
Mailing Address - Fax:434-237-7793
Practice Address - Street 1:20715 TIMBERLAKE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7200
Practice Address - Country:US
Practice Address - Phone:434-237-7792
Practice Address - Fax:434-237-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000639103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1003028564Medicare PIN