Provider Demographics
NPI:1083349492
Name:SPENCE, RAYMOND Q III (LCADC, LAC)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:Q
Last Name:SPENCE
Suffix:III
Gender:M
Credentials:LCADC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 CHRISTOPHER ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-1201
Mailing Address - Country:US
Mailing Address - Phone:973-678-9852
Mailing Address - Fax:
Practice Address - Street 1:67 SANFORD ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1926
Practice Address - Country:US
Practice Address - Phone:973-673-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00317200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)