Healthcare Provider Details

I. General information

NPI: 1619005162
Provider Name (Legal Business Name): SPENCER COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SPENCER COUNSELING SERVICES, INC. 6500 ROCKSHIRE DR.
CHARLOTTE NC
28227-8059
US

IV. Provider business mailing address

SPENCER COUNSELING SERVICES, INC. P.O. BOX 43644
CHARLOTTE NC
28215-0042
US

V. Phone/Fax

Practice location:
  • Phone: 704-451-8769
  • Fax: 704-567-0189
Mailing address:
  • Phone: 704-451-8769
  • Fax: 704-567-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5042
License Number StateNC

VIII. Authorized Official

Name: MS. ERNESTINE SPENCER
Title or Position: OWNER AND THERAPIST
Credential: LPC
Phone: 704-451-8769