Healthcare Provider Details

I. General information

NPI: 1548991292
Provider Name (Legal Business Name): SPENCER RYAN LLOYD LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MORRIS ST
CHARLESTON WV
25301-1326
US

IV. Provider business mailing address

99 CRACKER BARREL DR STE 100
BARBOURSVILLE WV
25504-1650
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-7851
  • Fax: 304-525-1073
Mailing address:
  • Phone: 304-525-7851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00946206
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: