Healthcare Provider Details

I. General information

NPI: 1710117486
Provider Name (Legal Business Name): PAULA E SLOAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 GREENLAND DR
GREENVILLE SC
29615-3018
US

IV. Provider business mailing address

45 GREENLAND DR
GREENVILLE SC
29615-3018
US

V. Phone/Fax

Practice location:
  • Phone: 864-467-1788
  • Fax: 864-235-4789
Mailing address:
  • Phone: 864-467-1788
  • Fax: 864-235-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number510
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number510
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: