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General NPI Number Information
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NPI Number | 1447343280
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Entity Type | Individual
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Provider Name | NIKIYA S SPENCE LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 1400 BUFORD HWY STE C1
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City | BUFORD
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State | GA
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Zip | 30518-8722
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Country | US
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Telephone | 770-638-7145
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Fax | 404-287-2964
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Provider Business Mailing Address
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Address Line | 2175 SORRENTO CT
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City | BUFORD
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State | GA
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Zip | 30519-9900
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Country | US
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Telephone | 707-638-7145
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Fax | 404-287-2964
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 003382
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License Number State | GA
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