1346858305 NPI number — MRS. GWENDOLYN DANIELS SLADE RESIDENT COUNSELOR

Table of content: MRS. GWENDOLYN DANIELS SLADE RESIDENT COUNSELOR (NPI 1346858305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346858305 NPI number — MRS. GWENDOLYN DANIELS SLADE RESIDENT COUNSELOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLADE
Provider First Name:
GWENDOLYN
Provider Middle Name:
DANIELS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RESIDENT COUNSELOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346858305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 CANOE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23703-5380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-675-5416
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 CANOE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23703-5380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-673-3644
Provider Business Practice Location Address Fax Number:
757-337-0165
Provider Enumeration Date:
07/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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