Provider Demographics
NPI:1316373178
Name:SPENCER, BONNIE RENEE (LAPC)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:RENEE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 KRISTINS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-1815
Mailing Address - Country:US
Mailing Address - Phone:912-510-9294
Mailing Address - Fax:
Practice Address - Street 1:104 LAKESHORE DR
Practice Address - Street 2:SUITE D
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3803
Practice Address - Country:US
Practice Address - Phone:912-729-1120
Practice Address - Fax:912-729-1150
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional