MEDICARE: MS. ELIZABETH DACUS SLANE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C000767	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7684N	OTHER	NC	BCBS PROVIDER NUMBER
2	1817536	OTHER	NC	AETNA PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346207511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH DACUS SLANE LCSW

Provider Business Mailing Address
First Line	:	3541 RANDOLPH RD
Second Line	:	SUITE 102
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1032
Country	:	US
Telephone Number	:	704-365-1450
Fax Number	:	704-366-6464

Provider Business Practice Location Address
First Line	:	3541 RANDOLPH RD
Second Line	:	SUITE 102
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1032
Country	:	US
Telephone Number	:	704-365-1450
Fax Number	:	704-366-6464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2006
Last Update Date	:	07/09/2007

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