Provider Demographics
NPI:1306490313
Name:SLATE, MICHAEL GRAY (LCMHC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GRAY
Last Name:SLATE
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8593
Mailing Address - Country:US
Mailing Address - Phone:336-356-2600
Mailing Address - Fax:336-356-2601
Practice Address - Street 1:701 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8593
Practice Address - Country:US
Practice Address - Phone:336-356-2600
Practice Address - Fax:336-356-2601
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11868101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health