Provider Demographics
NPI:1326184383
Name:SPICA, DANIEL MALCOLM (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MALCOLM
Last Name:SPICA
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:800 BLOWS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7633
Mailing Address - Country:US
Mailing Address - Phone:865-531-9088
Mailing Address - Fax:865-531-9089
Practice Address - Street 1:220 FORT SANDERS WEST BLVD
Practice Address - Street 2:MOB 2. SUITE 300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3398
Practice Address - Country:US
Practice Address - Phone:865-531-9088
Practice Address - Fax:865-531-9089
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2558103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical