Doctor Name: | LISA SLOAN |
NPI Number: | 1467725390 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | |
Business Practice Address: | 4250 Fowler Ln Ste 204 Diamond Springs, CA - 956199782 |
Business Phone Number: | 5306263105 |
Business Fax Number: | 5306421233 |
Mailing Address: | Po Box 1987, DIAMOND SPRINGS |
State: | CA |
Postal Code: | 956191987 |
Phone Number: | 5306263105 |
Fax Number: | 5306421233 |
NPI Enumeration Date: | 02/23/2012 |
NPI Last Update Date: | 02/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |