Provider Demographics
NPI:1427660687
Name:SLAYTON, AMY LOUISE (LCSW-A)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:SLAYTON
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 DOCK ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4936
Mailing Address - Country:US
Mailing Address - Phone:910-524-9898
Mailing Address - Fax:910-254-9818
Practice Address - Street 1:1501 DOCK ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4936
Practice Address - Country:US
Practice Address - Phone:910-524-9898
Practice Address - Fax:910-254-9818
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0149991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical