Healthcare Provider Details

I. General information

NPI: 1164338638
Provider Name (Legal Business Name): MIRANDA ELAINE SPENCER LCMHC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 RANDALL PKWY STE 102
WILMINGTON NC
28403-2845
US

IV. Provider business mailing address

5002 RANDALL PKWY STE 102
WILMINGTON NC
28403-2845
US

V. Phone/Fax

Practice location:
  • Phone: 910-627-5524
  • Fax: 910-900-7634
Mailing address:
  • Phone: 910-627-5524
  • Fax: 910-900-7634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23332
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: