Doctor Name: | MS. MARLA S. SLACK |
NPI Number: | 1932308061 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 001271 |
Business Practice Address: | 300 Church St Yalesville, CT - 064922253 |
Business Phone Number: | 8604161464 |
Business Fax Number: | |
Mailing Address: | 300 Church St, YALESVILLE |
State: | CT |
Postal Code: | 064922253 |
Phone Number: | 8604161464 |
Fax Number: | |
NPI Enumeration Date: | 07/18/2007 |
NPI Last Update Date: | 06/07/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 001271 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |