Healthcare Provider Details

I. General information

NPI: 1558096842
Provider Name (Legal Business Name): ANDREA SPOMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BRIDGES RD STE F
MAULDIN SC
29662-3260
US

IV. Provider business mailing address

140 BRIDGES RD STE F
MAULDIN SC
29662-3260
US

V. Phone/Fax

Practice location:
  • Phone: 864-605-1449
  • Fax:
Mailing address:
  • Phone: 864-605-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451022393
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number10710
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: