Healthcare Provider Details

I. General information

NPI: 1851791487
Provider Name (Legal Business Name): SES SPENCER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 CHAFFIN RIDGE CT
ROSWELL GA
30075-2351
US

IV. Provider business mailing address

365 CHAFFIN RIDGE CT
ROSWELL GA
30075-2351
US

V. Phone/Fax

Practice location:
  • Phone: 678-462-5696
  • Fax: 678-373-3428
Mailing address:
  • Phone: 678-462-5696
  • Fax: 678-373-3428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003872
License Number StateGA

VIII. Authorized Official

Name: MRS. SUSAN S SPENCER
Title or Position: OWNER
Credential: L.C.S.W.
Phone: 678-462-5696