Provider Demographics
NPI:1568043859
Name:SLEDGE, TABRE'A LASCHAYE (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:TABRE'A
Middle Name:LASCHAYE
Last Name:SLEDGE
Suffix:
Gender:
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W MILLBROOK RD STE 210
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4490
Mailing Address - Country:US
Mailing Address - Phone:984-218-4675
Mailing Address - Fax:
Practice Address - Street 1:1631 MIDTOWN PL STE 104-125
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-1300
Practice Address - Country:US
Practice Address - Phone:984-218-4675
Practice Address - Fax:919-882-0986
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0166951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid