Provider Demographics
NPI:1316593072
Name:SPENCE, ANDREW DAVID (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:SPENCE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:SPENCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:125 N WILLOW ST STE B
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9000 GLACIER HWY STE 306
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8097
Practice Address - Country:US
Practice Address - Phone:907-321-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCSWS5651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical