Provider Demographics
NPI:1174724546
Name:SLOCUM, TEQUILA LASHAUN
Entity type:Individual
Prefix:
First Name:TEQUILA
Middle Name:LASHAUN
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TEQUILA1
Other - Middle Name:LASHAUN
Other - Last Name:UPSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4443 MILLVALE DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-5617
Mailing Address - Country:US
Mailing Address - Phone:404-751-7809
Mailing Address - Fax:
Practice Address - Street 1:9238 MADISON BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9100
Practice Address - Country:US
Practice Address - Phone:256-774-8342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor