Healthcare Provider Details

I. General information

NPI: 1134033418
Provider Name (Legal Business Name): ERIK JAZZ SPENCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 HIGH ST STE 701
BOSTON MA
02110-3025
US

IV. Provider business mailing address

110 GUM ST
DUNN NC
28334-8421
US

V. Phone/Fax

Practice location:
  • Phone: 919-810-1459
  • Fax:
Mailing address:
  • Phone: 984-249-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP024504
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: