MEDICARE: MR. CLARENCE EDWARD SLAUGHTER JR. LICSW

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	1041C0700X	Clinical Social Worker	LW00005244	WA

General Provider Information

NPI Number	:	1669111431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLARENCE EDWARD SLAUGHTER JR. LICSW

Provider Business Mailing Address
First Line	:	3015 BROAD BRANCH CIR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-6463
Country	:	US
Telephone Number	:	314-540-3115
Fax Number	:

Provider Business Practice Location Address
First Line	:	3015 BROAD BRANCH CIR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-6463
Country	:	US
Telephone Number	:	314-540-3115
Fax Number	:

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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Directions to “ MR. CLARENCE EDWARD SLAUGHTER JR. LICSW” Practice Location

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