Healthcare Provider Details

I. General information

NPI: 1770209231
Provider Name (Legal Business Name): BRITTANY NICOLE SPOOR LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SOLAREX CT UNIT 201
FREDERICK MD
21703-8655
US

IV. Provider business mailing address

604 SOLAREX CT UNIT 201
FREDERICK MD
21703-8655
US

V. Phone/Fax

Practice location:
  • Phone: 443-761-4270
  • Fax: 301-682-5326
Mailing address:
  • Phone: 443-761-4270
  • Fax: 301-682-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP13012
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: