Healthcare Provider Details

I. General information

NPI: 1063839876
Provider Name (Legal Business Name): SHANA SLONE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7629 KY ROUTE 979
GRETHEL KY
41631-6304
US

IV. Provider business mailing address

1709 KY ROUTE 321 STE 3
PRESTONSBURG KY
41653-9097
US

V. Phone/Fax

Practice location:
  • Phone: 606-587-2200
  • Fax:
Mailing address:
  • Phone: 606-886-8546
  • Fax: 606-886-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255195
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: