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General NPI Number Information
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NPI Number | 1316141377
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Entity Type | Individual
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Provider Name | NICOLE ANTOINETTE WARE SPENCER PSY D
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Gender | Female
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 4325 1ST AVE # 1461
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City | TUCKER
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State | GA
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Zip | 30084-4498
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Country | US
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Telephone | 678-404-1077
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1461
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City | TUCKER
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State | GA
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Zip | 30085-1461
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Country | US
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Telephone | 470-810-7811
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301013431
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY004171
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License Number State | GA
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