Provider Demographics
NPI:1346973658
Name:SPENCE, BIANCA ALEXIS (MS)
Entity Type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:ALEXIS
Last Name:SPENCE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BELL RICHARD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459-3505
Mailing Address - Country:US
Mailing Address - Phone:575-386-9358
Mailing Address - Fax:
Practice Address - Street 1:155 BELL RICHARD AVE
Practice Address - Street 2:
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-3505
Practice Address - Country:US
Practice Address - Phone:575-386-9358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator