Provider Demographics
NPI:1811245806
Name:SLATER, NEICO SHALON (MS)
Entity type:Individual
Prefix:MRS
First Name:NEICO
Middle Name:SHALON
Last Name:SLATER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W THARPE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5374
Mailing Address - Country:US
Mailing Address - Phone:850-561-8060
Mailing Address - Fax:850-561-1143
Practice Address - Street 1:1000 W THARPE ST STE 100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5374
Practice Address - Country:US
Practice Address - Phone:850-561-8060
Practice Address - Fax:850-561-1143
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist