Healthcare Provider Details

I. General information

NPI: 1336318682
Provider Name (Legal Business Name): KEISHA MELISSA SLOANE LPC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 W MEADOWVIEW RD SUITE 105
GREENSBORO NC
27407-3706
US

IV. Provider business mailing address

PO BOX 2257
GREENSBORO NC
27402-2257
US

V. Phone/Fax

Practice location:
  • Phone: 336-455-3139
  • Fax: 336-450-1033
Mailing address:
  • Phone: 336-455-3139
  • Fax: 336-450-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6881
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6881
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6881
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: