Provider Demographics
NPI:1164728697
Name:SPENCER, RONALD ROY SR (LPC/S)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ROY
Last Name:SPENCER
Suffix:SR
Gender:M
Credentials:LPC/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3681 WINKLER AVENUE EXT
Mailing Address - Street 2:APT. 1017 BEACH CLUB
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9468
Mailing Address - Country:US
Mailing Address - Phone:334-233-7361
Mailing Address - Fax:
Practice Address - Street 1:3033 WINKLER AVENUE EXT
Practice Address - Street 2:VA OUTPATIENT CLINIC
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9413
Practice Address - Country:US
Practice Address - Phone:239-939-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS#0640101YP2500X
AL#2603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional