Basic Information
| Provider Information | |||||||||
| NPI: | 1669665725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLOAN | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | GWEN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA, NCC, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 TWIN OAKS DR | ||||||||
| Address2: | |||||||||
| City: | HAMPSTEAD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284433283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102701726 | ||||||||
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| Practice Location | |||||||||
| Address1: | 962 S FAYETTEVILLE ST | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272036410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366261500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 4218 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.