Provider Demographics
NPI:1295357085
Name:SPENCER HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:SPENCER HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:803-262-3667
Mailing Address - Street 1:2764 PLEASANT RD
Mailing Address - Street 2:STE A PMB 10701
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7214
Mailing Address - Country:US
Mailing Address - Phone:803-262-3667
Mailing Address - Fax:681-662-2733
Practice Address - Street 1:2764 PLEASANT RD
Practice Address - Street 2:STE A PMB 10701
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7214
Practice Address - Country:US
Practice Address - Phone:803-262-3667
Practice Address - Fax:681-662-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty