Healthcare Provider Details

I. General information

NPI: 1205846292
Provider Name (Legal Business Name): MICHAEL COLLINS SPRADLIN LCSW, BCD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BLVD ATTN: SWS
BAY PINES FL
33744
US

IV. Provider business mailing address

12727 COLD STREAM DR
FORT MYERS FL
33912-4627
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax: 727-310-1330
Mailing address:
  • Phone: 239-561-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6991
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27035
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: