MEDICARE: SAMANTHA KAY SLATER M.S. ED, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PRC15149	DC

General Provider Information

NPI Number	:	1558968966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA KAY SLATER M.S. ED, LPC

Provider Business Mailing Address
First Line	:	1332 FARRAGUT ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-6908
Country	:	US
Telephone Number	:	419-290-5113
Fax Number	:

Provider Business Practice Location Address
First Line	:	1332 FARRAGUT ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-6908
Country	:	US
Telephone Number	:	419-290-5113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	10/08/2020

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