Provider Demographics
NPI:1235900093
Name:SPENCE, ANTEIA D (SUDRC)
Entity Type:Individual
Prefix:
First Name:ANTEIA
Middle Name:D
Last Name:SPENCE
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5291 HILLTOP RD APT C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5285
Mailing Address - Country:US
Mailing Address - Phone:919-268-2508
Mailing Address - Fax:
Practice Address - Street 1:5291 HILLTOP RD APT C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-5285
Practice Address - Country:US
Practice Address - Phone:919-268-2508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16005101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)