Provider Demographics
NPI:1306455571
Name:SLATON, MARY (LPC, NCC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SLATON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CROSSCOVE CIR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4026
Mailing Address - Country:US
Mailing Address - Phone:832-721-6349
Mailing Address - Fax:
Practice Address - Street 1:141 CROSSCOVE CIR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4026
Practice Address - Country:US
Practice Address - Phone:832-721-6349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3773101YP2500X
TX19733101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional