MEDICARE: SPENCER COUNSELING SERVICES, INC.

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	101YP2500X	Professional Counselor	5042	NC

General Provider Information

NPI Number	:	1619005162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPENCER COUNSELING SERVICES, INC.

Provider Business Mailing Address
First Line	:	SPENCER COUNSELING SERVICES, INC.
Second Line	:	P.O. BOX 43644
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-0042
Country	:	US
Telephone Number	:	704-451-8769
Fax Number	:	704-567-0189

Provider Business Practice Location Address
First Line	:	SPENCER COUNSELING SERVICES, INC.
Second Line	:	6500 ROCKSHIRE DR.
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-8059
Country	:	US
Telephone Number	:	704-451-8769
Fax Number	:	704-567-0189

Authorized Official
Title or Position	:	OWNER AND THERAPIST
Name	:	MS. ERNESTINE SPENCER
Credential	:	LPC
Telephone Number	:	704-451-8769

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/22/2020

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