Provider Demographics
NPI:1437894235
Name:SPENCER, ADELA NICOLE
Entity Type:Individual
Prefix:
First Name:ADELA
Middle Name:NICOLE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:PA
Mailing Address - Zip Code:19367-0210
Mailing Address - Country:US
Mailing Address - Phone:302-604-1000
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 250
Practice Address - Street 2:
Practice Address - City:PIPERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18947-0250
Practice Address - Country:US
Practice Address - Phone:267-528-9061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA171M00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator