Healthcare Provider Details

I. General information

NPI: 1114840535
Provider Name (Legal Business Name): TIA SPENCER LCPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PROMENADE AVE
SACO ME
04072-2952
US

IV. Provider business mailing address

4 PROMENADE AVE
SACO ME
04072-2952
US

V. Phone/Fax

Practice location:
  • Phone: 207-446-8147
  • Fax:
Mailing address:
  • Phone: 207-446-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberXL8875
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: