=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538436001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMMA LEE SLATER LPCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2011
-----------------------------------------------------
Last Update Date | 11/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 486 SPAULDING RD STE B
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28752-5212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-652-2919
-----------------------------------------------------
Fax | 828-652-2981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4929 DYSARTSVILLE RD
-----------------------------------------------------
City | MORGANTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28655-7163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-652-2919
-----------------------------------------------------
Fax | 828-652-2981
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | A9097
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------