Healthcare Provider Details

I. General information

NPI: 1801849088
Provider Name (Legal Business Name): JERRY L. SLOAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 CANTERWOOD DR
WILMINGTON NC
28401-7300
US

IV. Provider business mailing address

2311 CANTERWOOD DR
WILMINGTON NC
28401-7300
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-2385
  • Fax: 910-763-1482
Mailing address:
  • Phone: 910-763-2385
  • Fax: 910-763-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number340
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number340
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: