Healthcare Provider Details

I. General information

NPI: 1023965548
Provider Name (Legal Business Name): JARRELL SLADE LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CLIPPER MILL RD STE 221
BALTIMORE MD
21211-1946
US

IV. Provider business mailing address

3705 33RD ST APT 3C
MOUNT RAINIER MD
20712-2082
US

V. Phone/Fax

Practice location:
  • Phone: 443-320-2313
  • Fax:
Mailing address:
  • Phone: 301-385-8872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC17550
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: