MEDICARE: PRINCESS SPIKES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904018162	VA
2	1041C0700X	Clinical Social Worker	118740	TX
3	1041C0700X	Clinical Social Worker	TPSW6689	FL
4	1041C0700X	Clinical Social Worker	16807	CT
5	1041C0700X	Clinical Social Worker	CSW.09931672	CO
6	1041C0700X	Clinical Social Worker	17752	SC
7	1041C0700X	Clinical Social Worker	C018499	NC
8	1041C0700X	Clinical Social Worker	6148C	AL

General Provider Information

NPI Number	:	1598466914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCESS SPIKES

Provider Business Mailing Address
First Line	:	1526 CARTER ST
Second Line	:
City	:	ANNISTON
State	:	AL
Zip	:	36201-3437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1526 CARTER ST
Second Line	:
City	:	ANNISTON
State	:	AL
Zip	:	36201-3437
Country	:	US
Telephone Number	:	804-604-6643
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	05/18/2026

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Directions to “ PRINCESS SPIKES ” Practice Location

Language	Start Address	Practice Location

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