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General NPI Number Information
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NPI Number | 1689221525
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Entity Type | Organization
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Legal Business Name | SPENCE CLINICAL SERVICES, PLLC
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 100 FOX GLOVE DR
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City | MOORESVILLE
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State | NC
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Zip | 28115-3630
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Country | US
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Telephone | 704-621-7154
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 264
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City | MOORESVILLE
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State | NC
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Zip | 28115-0264
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Country | US
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Telephone | 704-621-7154
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Fax |
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Authorized Official
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Title or Position | OWNDER
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Name | KRISTIN F HEPLER
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Credential | LPCS, LCAS, CCS
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Telephone | 704-621-7154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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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