=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285651901
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WAYDE ZANE SLOCUMB L.P.C., N.C.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 08/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 WHITESPORT CIR SW
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-6444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-533-9393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1128 MAHAN DR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758-1306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-797-6095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 1538
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------