Provider Demographics
NPI:1043060379
Name:SPENCER, ALQUAN (CADC)
Entity Type:Individual
Prefix:
First Name:ALQUAN
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 WOODRUFF LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2022
Mailing Address - Country:US
Mailing Address - Phone:908-352-0850
Mailing Address - Fax:
Practice Address - Street 1:850 WOODRUFF LN
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2022
Practice Address - Country:US
Practice Address - Phone:908-352-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00175400101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)