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General NPI Number Information
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NPI Number | 1588538151
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Entity Type | Organization
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Legal Business Name | THE SLUG HOUSE, LLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 10419 OLD PLACERVILLE RD STE 258
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City | SACRAMENTO
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State | CA
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Zip | 95827-2527
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Country | US
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Telephone | 916-678-1778
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Fax |
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Provider Business Mailing Address
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Address Line | 10419 OLD PLACERVILLE RD STE 258
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City | SACRAMENTO
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State | CA
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Zip | 95827-2527
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Country | US
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Telephone | 916-678-1778
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NICK XIONG
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Credential | PSYD
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Telephone | 704-426-9743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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