Provider Demographics
NPI:1558038000
Name:SLEDGE, KEDRIC (LCSW)
Entity type:Individual
Prefix:
First Name:KEDRIC
Middle Name:
Last Name:SLEDGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-4930
Mailing Address - Country:US
Mailing Address - Phone:678-241-9841
Mailing Address - Fax:
Practice Address - Street 1:113 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-4930
Practice Address - Country:US
Practice Address - Phone:678-241-9841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEQ3-0010435OtherLMSW