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General NPI Number Information
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NPI Number | 1881189421
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Entity Type | Individual
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Provider Name | KAWANZA SPENCER OWNER, REGISTEINTERN
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Gender | Female
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 6866 PINE FOREST RD STE A
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City | PENSACOLA
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State | FL
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Zip | 32526-6903
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Country | US
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Telephone | 850-972-9897
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Fax | 850-972-9898
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Provider Business Mailing Address
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Address Line | 6888 PINE FOREST ROAD SUITE A
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City | PENSACOLA
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State | FL
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Zip | 32526-2673
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Country | US
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Telephone | 850-972-9897
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Fax | 850-972-9898
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1830
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1830
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1830
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1830
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 1830
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 15681
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License Number State | FL
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