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General NPI Number Information
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NPI Number | 1134482409
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Entity Type | Organization
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Legal Business Name | SPECTRA SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 390 REED RD FL 1
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City | BROOMALL
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State | PA
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Zip | 19008-4008
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Country | US
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Telephone | 484-450-6476
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Fax | 484-450-6476
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Provider Business Mailing Address
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Address Line | 390 REED RD FL 1
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City | BROOMALL
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State | PA
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Zip | 19008-4008
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Country | US
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Telephone | 484-450-6476
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Fax | 484-224-3398
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Authorized Official
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Title or Position | DIRECTOR/ CO-OWNER
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Name | MRS. MALEITA MARGUERITE OLSON
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Credential | LCSW
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Telephone | 484-450-6476
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BH000073
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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