Healthcare Provider Details

I. General information

NPI: 1891183752
Provider Name (Legal Business Name): SHAWDI SPENCER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12821 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3012
US

IV. Provider business mailing address

12821 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3012
US

V. Phone/Fax

Practice location:
  • Phone: 818-432-5025
  • Fax: 818-432-0872
Mailing address:
  • Phone: 818-432-5025
  • Fax: 818-432-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: