Healthcare Provider Details

I. General information

NPI: 1609770478
Provider Name (Legal Business Name): FERNWEH THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 09/14/2026
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: 616-610-9211
  • Fax:
Mailing address:
  • Phone: 616-610-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREA ARIEL SPOMER
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 616-610-9211