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General NPI Number Information
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NPI Number | 1215260609
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Entity Type | Organization
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Legal Business Name | PATRICIA LEWIS-SLAYTON, LCSW LMFT. INC
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 1100 S PONCE DE LEON BLVD STE 1
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-6013
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Country | US
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Telephone | 904-824-7733
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Fax | 904-829-9768
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Provider Business Mailing Address
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Address Line | 2112 W. LYMINGTON WAY
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City | ST. AUGUSTINE
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State | FL
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Zip | 32084
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Country | US
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Telephone | 904-824-7733
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. PATRICIA LEWIS-SLAYTON
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Credential | LCSW. LMFT
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Telephone | 904-822-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW1594
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License Number State | FL
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