Healthcare Provider Details

I. General information

NPI: 1699045542
Provider Name (Legal Business Name): AMY RENAE SPURLOCK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 KANAWHA STATE FOREST DR
CHARLESTON WV
25314-9080
US

IV. Provider business mailing address

PO BOX 8880
SOUTH CHARLESTON WV
25303-0880
US

V. Phone/Fax

Practice location:
  • Phone: 304-389-5730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2022
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: