Provider Demographics
NPI:1962416925
Name:SLAYDON, JULIAN THOMAS JR (LMFT)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:THOMAS
Last Name:SLAYDON
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 W KINGS HWY STE D
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5076
Mailing Address - Country:US
Mailing Address - Phone:336-552-5986
Mailing Address - Fax:
Practice Address - Street 1:424 W KINGS HWY STE D
Practice Address - Street 2:SUITE 2
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5076
Practice Address - Country:US
Practice Address - Phone:336-552-5986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC761106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105092Medicaid
NC140NUOtherBLUE CROSS BLUE SHIELD