Provider Demographics
NPI:1437310588
Name:SPENCER, CONNIE MOORE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:MOORE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 MERRIMAN CT
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7703
Mailing Address - Country:US
Mailing Address - Phone:229-563-3225
Mailing Address - Fax:229-247-6887
Practice Address - Street 1:3820 MERRIMAN CT
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7703
Practice Address - Country:US
Practice Address - Phone:229-563-3225
Practice Address - Fax:229-247-6887
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health