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General NPI Number Information
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NPI Number | 1013159169
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Entity Type | Individual
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Provider Name | WANDA LYNN SPENCER ED.S.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 100 1ST AVE SW SUITE 202 C
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City | WINCHESTER
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State | TN
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Zip | 37398
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Country | US
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Telephone | 931-361-1333
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Fax |
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Provider Business Mailing Address
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Address Line | 100 1ST AVE SW SUITE 202 C
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City | WINCHESTER
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State | TN
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Zip | 37398
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Country | US
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Telephone | 931-636-7411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11507
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License Number State | TN
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