Healthcare Provider Details

I. General information

NPI: 1114703790
Provider Name (Legal Business Name): SHELLY LYNN SLONECKER MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/23/2023
Certification Date: 09/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 EDINBURGH SOUTH DR STE 130
CARY NC
27511-6456
US

IV. Provider business mailing address

4129 MITTGLEN LN
CARY NC
27518-5302
US

V. Phone/Fax

Practice location:
  • Phone: 919-462-8303
  • Fax: 919-462-0433
Mailing address:
  • Phone: 614-940-3105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018991
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: