MEDICARE: DR. SHIRLEY ANN SPOONER PH.D.

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	101YM0800X	Mental Health Counselor	MH1065	FL
2	101YP2500X	Professional Counselor	LPC003342	GA

General Provider Information

NPI Number	:	1902925803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRLEY ANN SPOONER PH.D.

Provider Business Mailing Address
First Line	:	11235 BOARDTOWN RD
Second Line	:
City	:	CHERRYLOG
State	:	GA
Zip	:	30522-2321
Country	:	US
Telephone Number	:	706-698-4144
Fax Number	:	706-492-3400

Provider Business Practice Location Address
First Line	:	942 BLUE RIDGE DR
Second Line	:
City	:	MC CAYSVILLE
State	:	GA
Zip	:	30555-2504
Country	:	US
Telephone Number	:	706-492-2020
Fax Number	:	706-492-3400

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	09/11/2025

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