Healthcare Provider Details

I. General information

NPI: 1548862659
Provider Name (Legal Business Name): SPENCER COUNSELING AND WELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5395 HOLBEIN GATE RD
WALKERTOWN NC
27051-9492
US

IV. Provider business mailing address

5395 HOLBEIN GATE RD
WALKERTOWN NC
27051-9492
US

V. Phone/Fax

Practice location:
  • Phone: 336-825-0980
  • Fax:
Mailing address:
  • Phone: 336-825-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ARIANA SPENCER
Title or Position: CEO
Credential: LCMHC
Phone: 336-825-0980