Provider Demographics
NPI:1033994728
Name:SPENCER, WENDY EUGINA (LPCA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:EUGINA
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 YELLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SASSAFRAS
Mailing Address - State:KY
Mailing Address - Zip Code:41759-8712
Mailing Address - Country:US
Mailing Address - Phone:606-497-0628
Mailing Address - Fax:800-426-9098
Practice Address - Street 1:25 CLYDEAN DR
Practice Address - Street 2:
Practice Address - City:LEBURN
Practice Address - State:KY
Practice Address - Zip Code:41831-8702
Practice Address - Country:US
Practice Address - Phone:606-785-1148
Practice Address - Fax:800-426-9098
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY285555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health