Healthcare Provider Details

I. General information

NPI: 1831444827
Provider Name (Legal Business Name): ERICA MARIE SPENCER PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 MARKET AVE N
CANTON OH
44702-1017
US

IV. Provider business mailing address

4121 LAKE VISTA RD
AKRON OH
44319-2621
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-7066
  • Fax:
Mailing address:
  • Phone: 330-730-8692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1000631
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: